Provider First Line Business Practice Location Address:
BOX 498, 1000 W. CARSON STREET
Provider Second Line Business Practice Location Address:
HARBOR-UCLA MEDICAL CENTER, DEPARTMENT OF PSYCHIATRY
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-222-3134
Provider Business Practice Location Address Fax Number:
310-328-7217
Provider Enumeration Date:
02/12/2007