Provider First Line Business Practice Location Address:
200 UCLA MEDICAL PLZ STE 265
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:
90095-5724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-2429
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2007