Provider First Line Business Practice Location Address:
323 S. LINCOLN BLVD
Provider Second Line Business Practice Location Address:
UCLA-VENICE DENTAL CLINIC
Provider Business Practice Location Address City Name:
VENICE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-392-4103
Provider Business Practice Location Address Fax Number:
310-392-8513
Provider Enumeration Date:
04/20/2007