Provider First Line Business Practice Location Address:
23781 MAQUINA AVE.
Provider Second Line Business Practice Location Address:
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-965-7204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2006