Provider First Line Business Practice Location Address:
12582 KENSINGTON RD
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:
90720-4749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-799-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2025