Provider First Line Business Practice Location Address:
224 E CLARA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HUENEME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93041-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-283-4737
Provider Business Practice Location Address Fax Number:
805-488-9000
Provider Enumeration Date:
07/15/2009