Provider First Line Business Practice Location Address:
200 UCLA MEDICAL PLZ
Provider Second Line Business Practice Location Address:
STE 135
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-8344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-794-7021
Provider Business Practice Location Address Fax Number:
310-794-7159
Provider Enumeration Date:
07/22/2006