Provider First Line Business Practice Location Address:
221 WESTWOOD PLAZA SUITE 221 CAMPUS SMILES UCLA
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:
90095-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-220-0486
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2023