Provider First Line Business Practice Location Address:
2160 FLETCHER PKWY
Provider Second Line Business Practice Location Address:
SUITE M
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-694-8994
Provider Business Practice Location Address Fax Number:
619-562-2584
Provider Enumeration Date:
10/17/2011