Provider First Line Business Practice Location Address:
3801 KATELLA AVE
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-3338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-431-6000
Provider Business Practice Location Address Fax Number:
562-431-7300
Provider Enumeration Date:
03/07/2012