Provider First Line Business Practice Location Address:
1620 CENTINELA AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90302-1045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-753-7860
Provider Business Practice Location Address Fax Number:
323-777-0265
Provider Enumeration Date:
12/08/2009