Provider First Line Business Practice Location Address:
1010 W LA VETA AVE STE 510
Provider Second Line Business Practice Location Address:
ST JOSEPH HOSPITAL MEDICAL TOWER
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-4305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-403-6300
Provider Business Practice Location Address Fax Number:
480-505-1842
Provider Enumeration Date:
11/03/2010