Provider First Line Business Practice Location Address:
8401 CALIFORNIA CITY BLVD
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
CALIFORNIA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93505-5277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-373-1150
Provider Business Practice Location Address Fax Number:
760-373-7841
Provider Enumeration Date:
06/01/2006