Provider First Line Business Practice Location Address:
9621 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
106
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-449-2000
Provider Business Practice Location Address Fax Number:
619-449-8303
Provider Enumeration Date:
08/18/2005