Provider First Line Business Practice Location Address:
101 THE CITY DRIVE SOUTH
Provider Second Line Business Practice Location Address:
DEPT OF ORTHO SURGERY, PAV III, 2ND FL, RTE 81
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:
949-824-4405
Provider Business Practice Location Address Fax Number:
714-456-7547
Provider Enumeration Date:
05/24/2019