Provider First Line Business Practice Location Address:
1 MED PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92697-1132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-6025
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2011