Provider First Line Business Practice Location Address:
6585 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-265-0072
Provider Business Practice Location Address Fax Number:
619-265-0073
Provider Enumeration Date:
05/14/2013