Provider First Line Business Practice Location Address:
1218 S INGLEWOOD 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:
90301-3649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-910-0399
Provider Business Practice Location Address Fax Number:
310-910-0384
Provider Enumeration Date:
01/19/2023