Provider First Line Business Practice Location Address:
2400 E 4TH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-470-4175
Provider Business Practice Location Address Fax Number:
619-472-4598
Provider Enumeration Date:
10/18/2010