Provider First Line Business Practice Location Address:
1328 22ND ST
Provider Second Line Business Practice Location Address:
ST. JOHN'S ANESTHESIA DEPARTMENT
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-2032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-712-0598
Provider Business Practice Location Address Fax Number:
818-712-0598
Provider Enumeration Date:
06/26/2006