Provider First Line Business Practice Location Address:
1000 WEST CARSON STREET BOX 19
Provider Second Line Business Practice Location Address:
HARBOR-UCLA MEDICAL CENTER
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90509-4225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-338-2401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2015