Provider First Line Business Practice Location Address:
12431 MAGNOLIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92841-3321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-829-3231
Provider Business Practice Location Address Fax Number:
626-703-4166
Provider Enumeration Date:
10/14/2026