Provider First Line Business Practice Location Address:
133 N. PRAIRIE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-4878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-419-0900
Provider Business Practice Location Address Fax Number:
310-622-8776
Provider Enumeration Date:
08/31/2006