Provider First Line Business Practice Location Address:
2340 TAMPA AVE STE A
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:
92020-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-301-2105
Provider Business Practice Location Address Fax Number:
619-644-1747
Provider Enumeration Date:
05/18/2007