Provider First Line Business Practice Location Address:
591 W CHANNEL ISLANDS BLVD.
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:
93041-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-985-9591
Provider Business Practice Location Address Fax Number:
805-985-9593
Provider Enumeration Date:
08/24/2006