Provider First Line Business Practice Location Address:
11818 AVENIDA MARCELLA
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:
92019-4060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-660-2138
Provider Business Practice Location Address Fax Number:
619-660-2138
Provider Enumeration Date:
10/11/2007