Provider First Line Business Practice Location Address:
9456 CUYAMACA ST STE 102
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:
92071-5919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-270-5665
Provider Business Practice Location Address Fax Number:
619-450-2111
Provider Enumeration Date:
10/19/2005