Provider First Line Business Practice Location Address:
2240 E PLAZA BLVD
Provider Second Line Business Practice Location Address:
SUITE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-267-5884
Provider Business Practice Location Address Fax Number:
619-267-6073
Provider Enumeration Date:
09/12/2006