Provider First Line Business Practice Location Address:
7918 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE N322
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-441-1027
Provider Business Practice Location Address Fax Number:
619-741-9422
Provider Enumeration Date:
02/12/2009