Provider First Line Business Practice Location Address:
649 W IMPERIAL HWY
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
BREA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-529-1232
Provider Business Practice Location Address Fax Number:
714-529-1232
Provider Enumeration Date:
11/01/2006