Provider First Line Business Practice Location Address:
1000 S HARBOR BLVD
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:
92805-5531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-517-8968
Provider Business Practice Location Address Fax Number:
714-956-2894
Provider Enumeration Date:
08/17/2026