Provider First Line Business Practice Location Address:
JOHN MCKAY CENTER USC
Provider Second Line Business Practice Location Address:
940 W. 35TH ST.
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-821-7363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2014