Provider First Line Business Practice Location Address: 
310 N SAN VICENTE BLVD
    Provider Second Line Business Practice Location Address: 
CEDARS SINAI BREAST CENTER
    Provider Business Practice Location Address City Name: 
WEST HOLLYWOOD
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
90048
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
310-423-9424
    Provider Business Practice Location Address Fax Number: 
310-423-9399
    Provider Enumeration Date: 
10/09/2014