Provider First Line Business Practice Location Address:
583 N 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92021-6449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-440-5800
Provider Business Practice Location Address Fax Number:
619-440-6999
Provider Enumeration Date:
12/20/2006