Provider First Line Business Practice Location Address:
10833 LE CONTE AVENUE ROOM A0-156B CHS
Provider Second Line Business Practice Location Address:
UC REGENTS MAXILLOFACIAL PROSTHODONTICS
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:
310-825-5889
Provider Business Practice Location Address Fax Number:
310-825-6345
Provider Enumeration Date:
11/20/2008