Provider First Line Business Practice Location Address:
7900 EL CAJON BLVD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-3655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-469-0494
Provider Business Practice Location Address Fax Number:
619-667-9050
Provider Enumeration Date:
04/16/2009