Individual
MR. ASA INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAS
Contact information
Practice address
2055 N PERRIS BLVD, PERRIS, CA 92571-2509
(951) 674-5354
(951) 674-5227
Mailing address
565 CHANEY ST, LAKE ELSINORE, CA 92530-2722
(951) 674-5354
(951) 674-5227
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
5542
CA
Other
Enumeration date
08/07/2007
Last updated
08/07/2007
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