Provider First Line Business Practice Location Address:
1480 S HARBOR BLVD
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
LAHABRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-870-5200
Provider Business Practice Location Address Fax Number:
714-870-5481
Provider Enumeration Date:
08/13/2007