Provider First Line Business Practice Location Address:
1110 W LA PALMA AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92801-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-533-1491
Provider Business Practice Location Address Fax Number:
714-533-0237
Provider Enumeration Date:
12/15/2006