Provider First Line Business Practice Location Address:
220 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:
90301-4615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-673-1093
Provider Business Practice Location Address Fax Number:
310-412-1460
Provider Enumeration Date:
04/02/2008