Provider First Line Business Practice Location Address:
1200 N. STATE ST., IRD 620,
Provider Second Line Business Practice Location Address:
LAC -USC MED CENTER,
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:
323-226-7556
Provider Business Practice Location Address Fax Number:
323-226-2657
Provider Enumeration Date:
04/11/2011