Provider First Line Business Practice Location Address:
1 LMU DR
Provider Second Line Business Practice Location Address:
ATHLETIC DEPARTMENT
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-252-9816
Provider Business Practice Location Address Fax Number:
424-253-2916
Provider Enumeration Date:
07/13/2005