Provider First Line Business Practice Location Address:
8201 CALIFORNIA CITY BLVD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
CALIFORNIA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93505-2672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-373-7939
Provider Business Practice Location Address Fax Number:
661-823-8474
Provider Enumeration Date:
10/17/2006