Provider First Line Business Practice Location Address:
757 WESTWOOD PLAZA
Provider Second Line Business Practice Location Address:
UCLA MED-GIM & HSR; BOX 957417, RRUMC #7501K
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-7417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-267-9643
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2007