Provider First Line Business Practice Location Address: 
2100 SOLAR DR STE 102
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
OXNARD
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93036-0649
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
805-988-9001
    Provider Business Practice Location Address Fax Number: 
805-988-9088
    Provider Enumeration Date: 
03/24/2015