Provider First Line Business Practice Location Address:
2010 ZONAL AVE
Provider Second Line Business Practice Location Address:
LACUSC MEDICAL CENTER GERIATRIC OPD3P22B
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-3638
Provider Business Practice Location Address Fax Number:
323-226-7429
Provider Enumeration Date:
11/19/2008