Provider First Line Business Practice Location Address:
933 CENTINELA AVE UNIT A
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:
90302-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-377-0012
Provider Business Practice Location Address Fax Number:
213-377-0044
Provider Enumeration Date:
01/01/2024