Provider First Line Business Practice Location Address:
7339 EL CAJON BLVD STE M
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-7435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-229-6842
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2011