Provider First Line Business Practice Location Address:
538 HOLT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLTVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92250-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-356-2821
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2005