Provider First Line Business Practice Location Address:
100 UCLA MEDICAL PLZ
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90024-6970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-208-2355
Provider Business Practice Location Address Fax Number:
310-824-2781
Provider Enumeration Date:
07/05/2006