Provider First Line Business Practice Location Address:
100 UCLA MEDICAL PLZ
Provider Second Line Business Practice Location Address:
SUITE 770
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-825-1965
Provider Business Practice Location Address Fax Number:
310-824-7830
Provider Enumeration Date:
05/16/2007