Provider First Line Business Practice Location Address:
2220 E PLAZA BLVD STE B
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:
91950-5162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-479-1771
Provider Business Practice Location Address Fax Number:
619-479-1135
Provider Enumeration Date:
11/08/2016