Provider First Line Business Practice Location Address:
170 TOWN CENTER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-5801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-449-8002
Provider Business Practice Location Address Fax Number:
619-449-8035
Provider Enumeration Date:
07/16/2006