Provider First Line Business Practice Location Address:
501 EAST HARDY STREET
Provider Second Line Business Practice Location Address:
SUITE 424
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-671-9980
Provider Business Practice Location Address Fax Number:
310-671-9982
Provider Enumeration Date:
09/11/2006