Provider First Line Business Practice Location Address:
11301 WILSHIRE BLVD.
Provider Second Line Business Practice Location Address:
BUILDING 500, DEPARTMENT OF SURGERY 10H2
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-622-9889
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2020