Provider First Line Business Practice Location Address:
100 UCLA MEDICAL PLAZA SUITE 345
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-6279
Provider Business Practice Location Address Fax Number:
310-206-0275
Provider Enumeration Date:
06/27/2007