Provider First Line Business Practice Location Address:
2501 HARBOR BLVD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF OEHS DIRECTOR, DR. DO
Provider Business Practice Location Address City Name:
COSTA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92626-6143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-957-5187
Provider Business Practice Location Address Fax Number:
714-957-5374
Provider Enumeration Date:
07/24/2006