Provider First Line Business Practice Location Address:
7918 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
N-307
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-993-7039
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006