Provider First Line Business Practice Location Address:
652 E MANCHESTER BLVD
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:
90301-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-777-4893
Provider Business Practice Location Address Fax Number:
424-227-7166
Provider Enumeration Date:
08/25/2011