Provider First Line Business Practice Location Address:
246 E SCOTT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HUENEME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93041-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-247-0708
Provider Business Practice Location Address Fax Number:
805-247-0508
Provider Enumeration Date:
05/10/2006