Provider First Line Business Practice Location Address:
16919 S. AINSWORTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-793-4263
Provider Business Practice Location Address Fax Number:
909-614-7255
Provider Enumeration Date:
05/12/2026