Provider First Line Business Practice Location Address: 
31872 COAST HWY
    Provider Second Line Business Practice Location Address: 
MISSION LAGUNA PATHOLOGY MEDICAL GROUP
    Provider Business Practice Location Address City Name: 
LAGUNA BEACH
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
92651-6773
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
949-499-7288
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/07/2007