Provider First Line Business Practice Location Address:
516 E CHAPMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92866-1603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-633-1648
Provider Business Practice Location Address Fax Number:
714-639-6351
Provider Enumeration Date:
09/27/2006