Provider First Line Business Practice Location Address:
DIVISION OF DERMATOLOGY CHS 52-121 10833 LE CONTE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-3010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-917-3376
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2023