Provider First Line Business Practice Location Address:
266 AVOCADO AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-4670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-444-6196
Provider Business Practice Location Address Fax Number:
619-444-6037
Provider Enumeration Date:
09/25/2006