Provider First Line Business Practice Location Address:
10031 LAMPSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92840-4716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-591-5106
Provider Business Practice Location Address Fax Number:
800-498-1631
Provider Enumeration Date:
12/30/2019