Provider First Line Business Practice Location Address:
325 W REGENT 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:
90301-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-671-6771
Provider Business Practice Location Address Fax Number:
310-644-2715
Provider Enumeration Date:
05/03/2007