Provider First Line Business Practice Location Address:
2250 ALCAZAR STREET
Provider Second Line Business Practice Location Address:
CSC #2200, DEPARTMENT OF PSYCHIATRY
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:
323-226-4984
Provider Business Practice Location Address Fax Number:
323-226-5751
Provider Enumeration Date:
10/10/2008