Provider First Line Business Practice Location Address:
1105 E PLAZA BLVD
Provider Second Line Business Practice Location Address:
#C
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:
619-477-1577
Provider Business Practice Location Address Fax Number:
619-477-6014
Provider Enumeration Date:
09/13/2007