Provider First Line Business Practice Location Address:
1500 E KATELLA AVE
Provider Second Line Business Practice Location Address:
SUITE R
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-639-1333
Provider Business Practice Location Address Fax Number:
714-639-3331
Provider Enumeration Date:
11/17/2006