Provider First Line Business Practice Location Address:
200 S. MANCHESTER AVENUE STE. 110
Provider Second Line Business Practice Location Address:
UCI MEDICAL CENTER
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-2332
Provider Business Practice Location Address Fax Number:
714-456-5997
Provider Enumeration Date:
10/16/2006