Provider First Line Business Practice Location Address:
205 CLAYDELLE AVE
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-4555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-441-0916
Provider Business Practice Location Address Fax Number:
619-441-0968
Provider Enumeration Date:
08/06/2007