Provider First Line Business Practice Location Address:
200 SOUTH A STREET
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93030-5717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-483-4804
Provider Business Practice Location Address Fax Number:
805-483-1304
Provider Enumeration Date:
09/19/2006