Provider First Line Business Practice Location Address:
403 WEST ADAMS BLVD.
Provider Second Line Business Practice Location Address:
CRAINOFACIAL CLEFT PALATE CLINIC 4TH FLOOR
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90007-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-742-1433
Provider Business Practice Location Address Fax Number:
213-742-1496
Provider Enumeration Date:
07/31/2006