Provider First Line Business Practice Location Address:
6945 EL CAJON BLVD
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:
92115-1754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-697-4600
Provider Business Practice Location Address Fax Number:
619-464-5526
Provider Enumeration Date:
10/31/2005