Provider First Line Business Practice Location Address:
UC REGENTS UCLA DEPT OF MED PROF GRP 100 MED PLAZA
Provider Second Line Business Practice Location Address:
SUITE 290,450,455,490,525,550,510,700
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-794-4955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2006