Provider First Line Business Practice Location Address:
300 UCLA MEDICAL PLZ
Provider Second Line Business Practice Location Address:
SUITE B200
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-9574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-794-1195
Provider Business Practice Location Address Fax Number:
310-794-7491
Provider Enumeration Date:
06/07/2010