Provider First Line Business Practice Location Address:
1400 S HARBOR BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LA HABRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90631-7577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-879-3400
Provider Business Practice Location Address Fax Number:
714-441-1998
Provider Enumeration Date:
06/28/2006