Provider First Line Business Practice Location Address:
1720 W BALL RD
Provider Second Line Business Practice Location Address:
STE.#1
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92804-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-991-5141
Provider Business Practice Location Address Fax Number:
714-991-5144
Provider Enumeration Date:
11/22/2006