Provider First Line Business Practice Location Address:
9800 S LA CIENEGA BLVD
Provider Second Line Business Practice Location Address:
STE 899, RM 1
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-4440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-449-5711
Provider Business Practice Location Address Fax Number:
877-725-7443
Provider Enumeration Date:
10/30/2013