Provider First Line Business Practice Location Address:
760 WESTWOOD PLZ # C8-193
Provider Second Line Business Practice Location Address:
UCLA PSYCHIATRY RES ED OFFICE
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-8353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-2412
Provider Business Practice Location Address Fax Number:
310-825-0340
Provider Enumeration Date:
06/01/2011