Provider First Line Business Practice Location Address:
1247 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE # 4
Provider Business Practice Location Address City Name:
NATIONAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91950-3552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-987-3232
Provider Business Practice Location Address Fax Number:
619-474-6061
Provider Enumeration Date:
10/01/2009