Provider First Line Business Practice Location Address:
300 S PIERCE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-698-1200
Provider Business Practice Location Address Fax Number:
586-698-1210
Provider Enumeration Date:
06/21/2007