Provider First Line Business Practice Location Address:
UCLA DIVISION OF PEDIATRIC NEUROLOGY
Provider Second Line Business Practice Location Address:
22-474 MDCC BOX 951752
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-825-6196
Provider Business Practice Location Address Fax Number:
310-825-5834
Provider Enumeration Date:
02/15/2007