Provider First Line Business Practice Location Address:
9862 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
STE. E
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-3873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-596-1600
Provider Business Practice Location Address Fax Number:
619-596-1680
Provider Enumeration Date:
10/04/2006