Provider First Line Business Practice Location Address:
1801 E. EDINGER AVE.
Provider Second Line Business Practice Location Address:
STE 190
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-834-1111
Provider Business Practice Location Address Fax Number:
714-834-1128
Provider Enumeration Date:
02/11/2011