Provider First Line Business Practice Location Address:
650 CHARLES E. YOUNG DRIVE SOUTH
Provider Second Line Business Practice Location Address:
100 UCLA MEDICAL PLAZA, SUITE 660
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-709-9379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2012