Provider First Line Business Practice Location Address:
LA COUNTY-USC MEDICAL CENTER, 1200 NORTH STATE STREET
Provider Second Line Business Practice Location Address:
ROOM 1011
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-6937
Provider Business Practice Location Address Fax Number:
323-226-6454
Provider Enumeration Date:
02/07/2008