Provider First Line Business Practice Location Address:
5300 KATELLA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-429-1200
Provider Business Practice Location Address Fax Number:
562-429-8070
Provider Enumeration Date:
04/27/2006