Provider First Line Business Practice Location Address:
5182 KATELLA AVENUE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-493-4655
Provider Business Practice Location Address Fax Number:
562-493-8897
Provider Enumeration Date:
08/04/2006