Provider First Line Business Practice Location Address:
9114 EDINGER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-841-6700
Provider Business Practice Location Address Fax Number:
714-841-6788
Provider Enumeration Date:
12/28/2006