Provider First Line Business Practice Location Address:
3531 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-1512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-584-8975
Provider Business Practice Location Address Fax Number:
619-584-0682
Provider Enumeration Date:
02/06/2007