Provider First Line Business Practice Location Address:
15228 S. HAWTHORNE BLVD.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAWNDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-679-8000
Provider Business Practice Location Address Fax Number:
310-644-3992
Provider Enumeration Date:
12/21/2006