Provider First Line Business Practice Location Address:
975 S AMBRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92806-4926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-533-9324
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2006