Provider First Line Business Practice Location Address:
500 E MANCHESTER BLVD
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:
90301-9294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-677-0501
Provider Business Practice Location Address Fax Number:
310-677-0053
Provider Enumeration Date:
07/02/2006