Provider First Line Business Practice Location Address:
101 CITY DR SOUTH
Provider Second Line Business Practice Location Address:
UCI MC, DEPT OF ANESTHESIA BLDG.53, RM.227, RT.81A
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:
714-456-6661
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2006