Provider First Line Business Practice Location Address:
1666 N. MAIN ST SUITE 400
Provider Second Line Business Practice Location Address:
WESTERN YOUTH SERVICES/BOYS AND GIRLS CLUB
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92701-4599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-532-7951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2009