Provider First Line Business Practice Location Address:
1670 E 120TH ST
Provider Second Line Business Practice Location Address:
MODULE 3A, UROLOGY
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-338-1559
Provider Business Practice Location Address Fax Number:
310-223-0977
Provider Enumeration Date:
03/08/2010