Provider First Line Business Practice Location Address:
1055 E LA HABRA BLVD
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
LA HABRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90631-5599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-691-3616
Provider Business Practice Location Address Fax Number:
562-691-8206
Provider Enumeration Date:
06/20/2005