Provider First Line Business Practice Location Address:
501 WEST CHANNEL ISLANDS BLVD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
PORT HUENEME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-985-9491
Provider Business Practice Location Address Fax Number:
805-382-4364
Provider Enumeration Date:
12/15/2006