Provider First Line Business Practice Location Address:
1230 W IMPERIAL HWY
Provider Second Line Business Practice Location Address:
STE# H
Provider Business Practice Location Address City Name:
LA HABRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90631-6987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-697-1878
Provider Business Practice Location Address Fax Number:
562-309-8279
Provider Enumeration Date:
10/26/2007