Provider First Line Business Practice Location Address:
9450 CUYAMACA ST
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-449-4673
Provider Business Practice Location Address Fax Number:
619-449-4680
Provider Enumeration Date:
09/30/2013