Provider First Line Business Practice Location Address:
3532 KATELLA AVE STE 112
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:
90720-3145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-644-2695
Provider Business Practice Location Address Fax Number:
619-644-2698
Provider Enumeration Date:
12/06/2006