Provider First Line Business Practice Location Address:
2700 W MANCHESTER BLVD
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:
90305-2436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-758-5161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2005