Provider First Line Business Practice Location Address:
1602 N LEMON ST
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:
92801-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-525-5558
Provider Business Practice Location Address Fax Number:
714-525-8238
Provider Enumeration Date:
11/28/2006