Provider First Line Business Practice Location Address:
218 E ELLIS AVE
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:
90302-1314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-424-2289
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2025