Provider First Line Business Practice Location Address:
10601 CALLE LEE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-2544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-575-6800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2026