Provider First Line Business Practice Location Address:
1215 E 17TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92701-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-547-4411
Provider Business Practice Location Address Fax Number:
714-547-4222
Provider Enumeration Date:
09/20/2006