Provider First Line Business Practice Location Address:
625 HUMANITIES QUAD
Provider Second Line Business Practice Location Address:
INTERCOLLEGIATE ATHLETICS BUILDING
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92697-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-396-4395
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2014