Provider First Line Business Practice Location Address:
321 E PT HUENEME ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HUENEME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93041-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-652-4267
Provider Business Practice Location Address Fax Number:
805-652-4288
Provider Enumeration Date:
08/31/2006