Provider First Line Business Practice Location Address:
24401 HEALTH CENTER DR.
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-770-4115
Provider Business Practice Location Address Fax Number:
949-770-3422
Provider Enumeration Date:
06/15/2005