Provider First Line Business Practice Location Address:
2222 W MANCHESTER BLVD STE B
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:
90305-2529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-751-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006