Provider First Line Business Practice Location Address:
100 UCLA MEDICAL PLZ # 410
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-7064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-824-4991
Provider Business Practice Location Address Fax Number:
310-824-7082
Provider Enumeration Date:
03/09/2007