Provider First Line Business Practice Location Address:
3110 E PLAZA BLVD
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:
91950-3932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-274-1672
Provider Business Practice Location Address Fax Number:
619-434-9667
Provider Enumeration Date:
08/26/2009