Provider First Line Business Practice Location Address:
1251 E IMPERIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACENTIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92870-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-528-8292
Provider Business Practice Location Address Fax Number:
714-528-8373
Provider Enumeration Date:
04/05/2016