Provider First Line Business Practice Location Address:
2101 GRANGER AVE
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:
91950-6208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-472-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2026