Provider First Line Business Practice Location Address:
11301 WILSHIRE BLVD BLDG 208
Provider Second Line Business Practice Location Address:
VA WEST LOS ANGELES HEALTHCARE CENTER
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-478-3711
Provider Business Practice Location Address Fax Number:
310-268-4781
Provider Enumeration Date:
08/19/2008