Provider First Line Business Practice Location Address:
1000 W CARSON ST
Provider Second Line Business Practice Location Address:
#492 HARBOR UCLA DEPARTMENT OF NEUROLOGY
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:
310-222-3897
Provider Business Practice Location Address Fax Number:
310-533-8905
Provider Enumeration Date:
10/20/2006