Provider First Line Business Practice Location Address:
4119 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:
92105-1119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-528-0053
Provider Business Practice Location Address Fax Number:
619-528-0628
Provider Enumeration Date:
01/17/2008