Provider First Line Business Practice Location Address:
405 W MANCHESTER BLVD
Provider Second Line Business Practice Location Address:
# 4
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-1196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-671-1447
Provider Business Practice Location Address Fax Number:
310-671-1444
Provider Enumeration Date:
05/29/2015