Provider First Line Business Practice Location Address:
1000 W IMPERIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA HABRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90631-6901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-459-6035
Provider Business Practice Location Address Fax Number:
714-459-6045
Provider Enumeration Date:
07/24/2006