Provider First Line Business Practice Location Address:
100 UCLA MEDICAL PLZ
Provider Second Line Business Practice Location Address:
SUITE 383
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90024-6970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-098-3102
Provider Business Practice Location Address Fax Number:
310-983-1034
Provider Enumeration Date:
11/14/2006