Provider First Line Business Practice Location Address:
11301 WILSHIRE BOULEVARD
Provider Second Line Business Practice Location Address:
VA MEDICAL CENTER, NEUROLOGY SERVICE (127)
Provider Business Practice Location Address City Name:
WEST 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:
310-268-3595
Provider Business Practice Location Address Fax Number:
310-268-4611
Provider Enumeration Date:
09/05/2006