Provider First Line Business Practice Location Address:
100 UCLA MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE #320
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-1668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-6252
Provider Business Practice Location Address Fax Number:
310-825-1903
Provider Enumeration Date:
04/15/2010