Provider First Line Business Practice Location Address:
1000 W CARSON ST # 497
Provider Second Line Business Practice Location Address:
HARBOR UCLA MEDICAL CENTER PMRT
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90502-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-222-4086
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006