Provider First Line Business Practice Location Address:
200 UCLA MEDICAL PLAZA, SUITE 365-C
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:
90095-5216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-7663
Provider Business Practice Location Address Fax Number:
310-267-2571
Provider Enumeration Date:
05/31/2011