Provider First Line Business Practice Location Address:
10525 HUMBOLT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-894-2120
Provider Business Practice Location Address Fax Number:
714-894-2150
Provider Enumeration Date:
02/17/2010