Provider First Line Business Practice Location Address:
940 W 35TH ST
Provider Second Line Business Practice Location Address:
USC ATHLETIC MEDICINE
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-361-2534
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2015