Provider First Line Business Practice Location Address:
118 MED SURGE I
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92697-4375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-824-0158
Provider Business Practice Location Address Fax Number:
949-824-4015
Provider Enumeration Date:
12/23/2007