Provider First Line Business Practice Location Address:
UCLA SCHOOL OF DENTISTRY
Provider Second Line Business Practice Location Address:
10833 LECONTE AVE 20-140
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:
310-206-1770
Provider Business Practice Location Address Fax Number:
310-206-5349
Provider Enumeration Date:
09/14/2006