Provider First Line Business Practice Location Address:
WEST LOS ANGELES VA MEDICAL CENTER
Provider Second Line Business Practice Location Address:
BUILDING 115 ROOM 107
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-673-9722
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2007