Provider First Line Business Practice Location Address:
520 N LA BREA AVE
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:
90302-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-294-4932
Provider Business Practice Location Address Fax Number:
323-294-2533
Provider Enumeration Date:
07/01/2019