Provider First Line Business Practice Location Address:
521 W CHANNEL ISLANDS BLVD
Provider Second Line Business Practice Location Address:
STE. 4
Provider Business Practice Location Address City Name:
PORT HUENEME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93041-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-984-1500
Provider Business Practice Location Address Fax Number:
805-382-8043
Provider Enumeration Date:
11/20/2006