Provider First Line Business Practice Location Address:
3751 KATELLA AVE DEPT OF
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:
90720-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-598-2411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2011