Provider First Line Business Practice Location Address:
1415 E 8TH ST
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
NATIONAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91950-2663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-474-2280
Provider Business Practice Location Address Fax Number:
619-474-2563
Provider Enumeration Date:
03/26/2007