Provider First Line Business Practice Location Address:
16485 SPRINGDALE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92649-2770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-846-3644
Provider Business Practice Location Address Fax Number:
714-846-7745
Provider Enumeration Date:
08/31/2006