Provider First Line Business Practice Location Address:
9460 CUYAMACA ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-5921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-569-1790
Provider Business Practice Location Address Fax Number:
619-312-4335
Provider Enumeration Date:
08/23/2007