Provider First Line Business Practice Location Address:
2940 JAMACHA RD STE L
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:
92019-4493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-660-0707
Provider Business Practice Location Address Fax Number:
619-660-1605
Provider Enumeration Date:
10/25/2006