Provider First Line Business Practice Location Address:
14445 OLIVE VIEW DRIVE
Provider Second Line Business Practice Location Address:
OLIVE VIEW UCLA MED CTR
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-364-3031
Provider Business Practice Location Address Fax Number:
818-364-4593
Provider Enumeration Date:
11/01/2006