Provider First Line Business Practice Location Address:
6150 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-3928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-569-0106
Provider Business Practice Location Address Fax Number:
619-286-0202
Provider Enumeration Date:
08/21/2006