Provider First Line Business Practice Location Address:
2112 OXFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARDIFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92007-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-803-5680
Provider Business Practice Location Address Fax Number:
760-944-3906
Provider Enumeration Date:
11/08/2013