Provider First Line Business Practice Location Address:
200 UCLA MEDICAL PLZ STE B165
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-3075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-301-6800
Provider Business Practice Location Address Fax Number:
310-794-9035
Provider Enumeration Date:
06/10/2006