Provider First Line Business Practice Location Address:
1265 AVOCADO AVE
Provider Second Line Business Practice Location Address:
104-197
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-7783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-368-4855
Provider Business Practice Location Address Fax Number:
619-390-8312
Provider Enumeration Date:
08/23/2006