Provider First Line Business Practice Location Address:
501 E HARDY ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-4054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-895-3100
Provider Business Practice Location Address Fax Number:
818-892-4651
Provider Enumeration Date:
08/07/2009