Provider First Line Business Practice Location Address:
100 UCLA MEDICAL PLZ STE 755
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:
90024-6990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-2386
Provider Business Practice Location Address Fax Number:
310-825-3285
Provider Enumeration Date:
08/20/2006