Provider First Line Business Practice Location Address:
9745 PROSPECT AVE STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-4294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-456-4822
Provider Business Practice Location Address Fax Number:
619-456-4825
Provider Enumeration Date:
11/14/2007