Provider First Line Business Practice Location Address:
412 W 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:
91950-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-474-5916
Provider Business Practice Location Address Fax Number:
619-474-8662
Provider Enumeration Date:
02/25/2008