Provider First Line Business Practice Location Address:
1280 W LAMBERT RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BREA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92821-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-691-7161
Provider Business Practice Location Address Fax Number:
562-691-7162
Provider Enumeration Date:
09/26/2006