Provider First Line Business Practice Location Address:
200 UCLA MEDICAL PLZ STE 140
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:
90095-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-794-7152
Provider Business Practice Location Address Fax Number:
310-794-1666
Provider Enumeration Date:
02/24/2006