Provider First Line Business Practice Location Address:
1200 N STATE STREET #1108
Provider Second Line Business Practice Location Address:
LOS ANGELES COUNTY UNIVERSITY OF SOUTHERN CALIFORNIA
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:
323-226-6225
Provider Business Practice Location Address Fax Number:
818-351-8126
Provider Enumeration Date:
05/18/2006