Provider First Line Business Practice Location Address:
1407 CENTINELA 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:
90302-1141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-330-2955
Provider Business Practice Location Address Fax Number:
310-330-2959
Provider Enumeration Date:
03/12/2007