Provider First Line Business Practice Location Address:
1224-1226 S BROOKHURST 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:
92804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-294-5550
Provider Business Practice Location Address Fax Number:
714-294-5551
Provider Enumeration Date:
03/20/2026