Provider First Line Business Practice Location Address:
10833 LECONTE AVE
Provider Second Line Business Practice Location Address:
UCHA MEDICAL CENTER DEPT OF MEDICINE ROOM 42 121 CHS
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-825-6264
Provider Business Practice Location Address Fax Number:
310-206-5511
Provider Enumeration Date:
04/10/2007