Provider First Line Business Practice Location Address:
165 E HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MOORPARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93021-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-341-3234
Provider Business Practice Location Address Fax Number:
805-529-5272
Provider Enumeration Date:
12/13/2006