Provider First Line Business Practice Location Address:
200 UCLA MEDICAL PLAZA, STE. 365-B
Provider Second Line Business Practice Location Address:
BOX 951693
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-1693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-794-9938
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2008