Provider First Line Business Practice Location Address:
1732 W MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92801-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-533-2117
Provider Business Practice Location Address Fax Number:
714-533-2131
Provider Enumeration Date:
09/18/2008