Provider First Line Business Practice Location Address:
2051 MARENGO ST, LACTUSC MEDICAL CENTER
Provider Second Line Business Practice Location Address:
INPATIENT TOWER-ADMIN SUITE C2K100
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-1352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-409-7414
Provider Business Practice Location Address Fax Number:
617-632-7626
Provider Enumeration Date:
06/02/2006