Provider First Line Business Practice Location Address:
800 PALM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMPERIAL BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91932-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-424-8989
Provider Business Practice Location Address Fax Number:
619-424-9614
Provider Enumeration Date:
11/02/2015