Provider First Line Business Practice Location Address:
17100 EUCLID STREET
Provider Second Line Business Practice Location Address:
PICU/PEDS DEPARTMENT
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-9270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-966-7253
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2012