Provider First Line Business Practice Location Address:
124 E 30TH ST STE A4
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:
91950-7332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-937-3990
Provider Business Practice Location Address Fax Number:
619-383-2300
Provider Enumeration Date:
03/21/2019