Provider First Line Business Practice Location Address:
1200 N STATE ST
Provider Second Line Business Practice Location Address:
LAC&USC MEDICAL CENTER, IPT ,AREA C3F, ROOM105
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-409-8840
Provider Business Practice Location Address Fax Number:
323-441-7205
Provider Enumeration Date:
05/12/2009