Provider First Line Business Practice Location Address:
10833 LE CONTE AVENUE
Provider Second Line Business Practice Location Address:
UCLA DENTISTRY CHS ROOM A3-078, ATTN DAVID KEATING
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-798-6476
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/25/2009