Provider First Line Business Practice Location Address:
2121 NEWCASTLE AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
CARDIFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92007-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-635-2528
Provider Business Practice Location Address Fax Number:
760-635-2524
Provider Enumeration Date:
03/23/2007