Provider First Line Business Practice Location Address:
1330 S KNOTT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92804-4711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-236-3800
Provider Business Practice Location Address Fax Number:
714-821-5073
Provider Enumeration Date:
02/16/2007