Provider First Line Business Practice Location Address:
541 W MANCHESTER BLVD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-330-3933
Provider Business Practice Location Address Fax Number:
310-330-3951
Provider Enumeration Date:
07/23/2006