Provider First Line Business Practice Location Address:
1481 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:
91950-3613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-477-2159
Provider Business Practice Location Address Fax Number:
619-477-2128
Provider Enumeration Date:
12/04/2006