Provider First Line Business Practice Location Address:
4650 SUNSET BLVD., MS #53
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF LOS ANGELES
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:
323-361-3814
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2008