Provider First Line Business Practice Location Address:
LAC & USC MEDICAL CENTER 1200 NO STATE STREET
Provider Second Line Business Practice Location Address:
RM 1011 UNIT I
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:
323-226-6935
Provider Business Practice Location Address Fax Number:
323-226-6454
Provider Enumeration Date:
11/06/2006