Provider First Line Business Practice Location Address:
4341 BIRCH STREET, SUITE #102
Provider Second Line Business Practice Location Address:
SELECTIVE REHAB
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-250-7870
Provider Business Practice Location Address Fax Number:
949-475-1003
Provider Enumeration Date:
06/08/2009