Provider First Line Business Practice Location Address:
1004 S C ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93030-7559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-483-7699
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2016