Provider First Line Business Practice Location Address:
1200 NORTH STATE STREET,
Provider Second Line Business Practice Location Address:
LAC USC MEDICAL CENTER CT-A7D
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-515-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2017