Provider First Line Business Practice Location Address:
4242 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:
92105-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-521-0013
Provider Business Practice Location Address Fax Number:
619-521-1067
Provider Enumeration Date:
03/30/2007