Provider First Line Business Practice Location Address:
1147 S BAKER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92707-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-661-0588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2026