Provider First Line Business Practice Location Address:
4776 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
#105
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-1206
Provider Business Practice Location Address Fax Number:
619-287-8975
Provider Enumeration Date:
04/27/2006