Provider First Line Business Practice Location Address:
2130 E 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATIONAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91950-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-267-6657
Provider Business Practice Location Address Fax Number:
619-267-7672
Provider Enumeration Date:
02/28/2007