Provider First Line Business Practice Location Address:
1400 W IMPERIAL HWY
Provider Second Line Business Practice Location Address:
I
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-690-7796
Provider Business Practice Location Address Fax Number:
562-690-3340
Provider Enumeration Date:
09/16/2006