Provider First Line Business Practice Location Address:
1132 E PLAZA BLVD
Provider Second Line Business Practice Location Address:
STE 202
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:
619-336-1536
Provider Business Practice Location Address Fax Number:
619-336-9911
Provider Enumeration Date:
09/05/2006