Provider First Line Business Practice Location Address:
455 S MAIN ST
Provider Second Line Business Practice Location Address:
CHOC - DEPARTMENT OF PEDIATRIC PSYCHOLOGY
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-532-8483
Provider Business Practice Location Address Fax Number:
714-532-8756
Provider Enumeration Date:
11/07/2006