Provider First Line Business Practice Location Address:
2720 E PLAZA BLVD
Provider Second Line Business Practice Location Address:
SUITE V
Provider Business Practice Location Address City Name:
NATIONAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91950-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-267-2378
Provider Business Practice Location Address Fax Number:
619-475-5052
Provider Enumeration Date:
11/01/2006