Provider First Line Business Practice Location Address:
3216 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-412-0200
Provider Business Practice Location Address Fax Number:
310-412-0600
Provider Enumeration Date:
12/06/2006