Provider First Line Business Practice Location Address:
1 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
BLDG. 820
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92697-3950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-824-0606
Provider Business Practice Location Address Fax Number:
855-209-8413
Provider Enumeration Date:
01/18/2017