Provider First Line Business Practice Location Address:
275 W MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-3405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-588-2420
Provider Business Practice Location Address Fax Number:
619-588-1324
Provider Enumeration Date:
05/04/2006