Provider First Line Business Practice Location Address:
128 N LOCUST ST
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:
90301-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-985-0133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2025