Provider First Line Business Practice Location Address:
1480 S HARBOR BLVD STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA HABRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90631-7562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-641-7141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2026