Provider First Line Business Practice Location Address:
1770 ORANGE AVE
Provider Second Line Business Practice Location Address:
PORTAL TO HEALING
Provider Business Practice Location Address City Name:
COSTA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-722-6797
Provider Business Practice Location Address Fax Number:
949-722-7291
Provider Enumeration Date:
05/04/2007