Provider First Line Business Practice Location Address:
300 UCLA MEDICAL PLZ STE 3300
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:
90095-7004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-825-0867
Provider Business Practice Location Address Fax Number:
310-794-5760
Provider Enumeration Date:
08/29/2018