Provider First Line Business Practice Location Address:
757 WESTWOOD BLVD. GONDA OBSERVATION UNIT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES, CA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-267-6654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2012