Provider First Line Business Practice Location Address:
4650 SUNSET BLVD. MS#53
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL LOS ANGELES
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-361-2350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2014