Provider First Line Business Practice Location Address:
6244 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-3918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-8225
Provider Business Practice Location Address Fax Number:
619-287-4146
Provider Enumeration Date:
03/27/2007