Provider First Line Business Practice Location Address:
1526 EDGEMONT ST.
Provider Second Line Business Practice Location Address:
ICD CLINIC, 2ND FLOOR CARDIOLOGY
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:
323-783-8861
Provider Business Practice Location Address Fax Number:
323-783-0122
Provider Enumeration Date:
06/21/2017