Provider First Line Business Practice Location Address:
323 N PRAIRIE AVE STE 401
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:
90301-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-412-2126
Provider Business Practice Location Address Fax Number:
310-412-2077
Provider Enumeration Date:
09/19/2008