Provider First Line Business Practice Location Address: 
UCLA DEPARTMENT OF OB/GYN 10833 LE CONTE AVE 27-139 CHS
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
LOS ANGELES
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
90095-1804
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
310-423-7417
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/27/2016