Provider First Line Business Practice Location Address:
1341 E 8TH ST
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
NATIONAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91950-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-474-8441
Provider Business Practice Location Address Fax Number:
619-474-1341
Provider Enumeration Date:
10/12/2006