Provider First Line Business Practice Location Address:
MPAC UCLA SEMEL INSTITUTE
Provider Second Line Business Practice Location Address:
760 WESTWOOD PLAZA, C8-852
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-1759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-5456
Provider Business Practice Location Address Fax Number:
310-206-8525
Provider Enumeration Date:
11/08/2016