Provider First Line Business Practice Location Address:
555 E HARDY ST
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:
90301-4011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-295-0075
Provider Business Practice Location Address Fax Number:
310-216-0775
Provider Enumeration Date:
10/06/2006