Provider First Line Business Practice Location Address:
5245 PACIFIC CONCOURSE DRIVE SUITE 100
Provider Second Line Business Practice Location Address:
NATIONAL UNIVERSITY NURSE MANAGED CLINIC
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90054-6905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-662-2052
Provider Business Practice Location Address Fax Number:
858-309-3480
Provider Enumeration Date:
01/08/2007