Provider First Line Business Practice Location Address:
62 CORPORATE PARK
Provider Second Line Business Practice Location Address:
BARRANCA MEDICAL PLAZA, SUITE 200
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-864-8261
Provider Business Practice Location Address Fax Number:
714-572-0572
Provider Enumeration Date:
11/18/2008