Provider First Line Business Practice Location Address:
340 E KELSO ST
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:
90301-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-714-7234
Provider Business Practice Location Address Fax Number:
562-222-7924
Provider Enumeration Date:
10/23/2025