Provider First Line Business Practice Location Address:
246 E SCOTT ST
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:
93041-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-271-0708
Provider Business Practice Location Address Fax Number:
805-271-0769
Provider Enumeration Date:
08/04/2006