Provider First Line Business Practice Location Address:
2051 MARENGO ST
Provider Second Line Business Practice Location Address:
LAC-USC MEDICAL CENTER, DEM, IPT, RM C1A108
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:
818-568-4860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2012