Provider First Line Business Practice Location Address:
USC SCHOOL OF DENTISTRY DEPARTMENT OF
Provider Second Line Business Practice Location Address:
925 WEST 34TH STREET, SUITE 312
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:
213-740-0410
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2009