Provider First Line Business Practice Location Address:
4132 KATELLA AVENUE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-3493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-814-0207
Provider Business Practice Location Address Fax Number:
562-598-5997
Provider Enumeration Date:
12/24/2007