Provider First Line Business Practice Location Address:
1127 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATIONAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91950-3517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-336-6063
Provider Business Practice Location Address Fax Number:
619-336-6066
Provider Enumeration Date:
08/12/2009