Provider First Line Business Practice Location Address:
3148 N HARTMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92865-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-414-6244
Provider Business Practice Location Address Fax Number:
816-817-4939
Provider Enumeration Date:
09/17/2013