Provider First Line Business Practice Location Address:
7098 EDINGER AVE
Provider Second Line Business Practice Location Address:
BEACH CITIES PODIATRY GROUP INC
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-848-3663
Provider Business Practice Location Address Fax Number:
714-848-0565
Provider Enumeration Date:
12/28/2005