Provider First Line Business Practice Location Address:
200 UCLA MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
LOS ANGALES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-0644
Provider Business Practice Location Address Fax Number:
310-825-3074
Provider Enumeration Date:
03/07/2008