Provider First Line Business Practice Location Address:
4290 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-493-4499
Provider Business Practice Location Address Fax Number:
562-493-6512
Provider Enumeration Date:
05/21/2013