Provider First Line Business Practice Location Address:
1119 S LA BREA 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-256-2246
Provider Business Practice Location Address Fax Number:
310-256-2248
Provider Enumeration Date:
09/16/2024