Provider First Line Business Practice Location Address:
10621 BLOOMFIELD ST
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-598-8889
Provider Business Practice Location Address Fax Number:
562-598-8879
Provider Enumeration Date:
12/27/2005