Provider First Line Business Practice Location Address:
11161 CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90303-2336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-590-1547
Provider Business Practice Location Address Fax Number:
310-590-1546
Provider Enumeration Date:
05/26/2006