Provider First Line Business Practice Location Address:
110 S LABREA
Provider Second Line Business Practice Location Address:
UNITED OPTICAL SUITE 450
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-672-0667
Provider Business Practice Location Address Fax Number:
310-672-0187
Provider Enumeration Date:
07/14/2006