Provider First Line Business Practice Location Address:
1 MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92697-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-7720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2018