Provider First Line Business Practice Location Address:
100 UCLA MEDICAL PLAZA SUITE 205
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:
855-423-8252
Provider Business Practice Location Address Fax Number:
310-423-0052
Provider Enumeration Date:
05/10/2017