Provider First Line Business Practice Location Address:
1000 W. CARSON STREET
Provider Second Line Business Practice Location Address:
BOX 17 HARBOR-UCLA MEDICAL CENTER
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-222-4175
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2008