Provider First Line Business Practice Location Address:
1920 E KATELLA AVE
Provider Second Line Business Practice Location Address:
SUITE M
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92867-5146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-633-7111
Provider Business Practice Location Address Fax Number:
714-633-2903
Provider Enumeration Date:
09/17/2006