Provider First Line Business Practice Location Address:
1505 N EDGEMONT ST
Provider Second Line Business Practice Location Address:
4TH FLOOR, NEUROSURGERY DEPT
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-5209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-783-4704
Provider Business Practice Location Address Fax Number:
323-783-8677
Provider Enumeration Date:
12/05/2005