Provider First Line Business Practice Location Address:
183 SOUTH FIRST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-328-1335
Provider Business Practice Location Address Fax Number:
619-328-1336
Provider Enumeration Date:
04/02/2008