Provider First Line Business Practice Location Address:
4616 EL CAJON BLVD STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-563-8212
Provider Business Practice Location Address Fax Number:
619-563-8211
Provider Enumeration Date:
12/03/2007