Provider First Line Business Practice Location Address:
10719 S INGLEWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90304-1793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-674-1115
Provider Business Practice Location Address Fax Number:
310-674-0713
Provider Enumeration Date:
05/18/2012