Provider First Line Business Practice Location Address:
2220 E. PLAZA BLVD
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
NATIONAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91950-5162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-267-0768
Provider Business Practice Location Address Fax Number:
619-267-1197
Provider Enumeration Date:
04/21/2017