Provider First Line Business Practice Location Address:
1210 S. LABREA 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:
90301-3891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-677-2779
Provider Business Practice Location Address Fax Number:
310-677-2741
Provider Enumeration Date:
05/14/2012