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:
90095-5804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-208-5400
Provider Business Practice Location Address Fax Number:
310-208-3788
Provider Enumeration Date:
08/09/2011