Provider First Line Business Practice Location Address:
10833 LE CONTE AVENUE
Provider Second Line Business Practice Location Address:
UCLA SCHOOL OF DENTISTRY ROOM A0-121
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-1668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-2933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2007