Provider First Line Business Practice Location Address:
4650 SUNSET BLVD.,
Provider Second Line Business Practice Location Address:
MS#76 , DIVISION OF GENERAL PEDIATRICS
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-361-6161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2010