Provider First Line Business Practice Location Address:
1480 S. HARBOR BLVD.
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
LA HABRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90631-7569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-446-8841
Provider Business Practice Location Address Fax Number:
714-446-8842
Provider Enumeration Date:
05/17/2007