Provider First Line Business Practice Location Address:
2716 OCEAN PARK BLVD. SUITE 3082
Provider Second Line Business Practice Location Address:
INSTITUTE FOR NERVE MEDICINE
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-314-6410
Provider Business Practice Location Address Fax Number:
310-314-2414
Provider Enumeration Date:
12/12/2013