Provider First Line Business Practice Location Address:
100 UCLA MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE 590
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-794-7422
Provider Business Practice Location Address Fax Number:
310-208-2158
Provider Enumeration Date:
07/09/2006