Provider First Line Business Practice Location Address:
1200 MERCANTILE ST
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:
93030-7522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-889-4150
Provider Business Practice Location Address Fax Number:
805-278-4007
Provider Enumeration Date:
12/26/2017