Provider First Line Business Practice Location Address:
1000 S LA BREA AVE STE 2
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:
90301-3869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-330-4818
Provider Business Practice Location Address Fax Number:
310-330-4822
Provider Enumeration Date:
11/03/2020