Provider First Line Business Practice Location Address:
343 E LEXINGTON AVE STE 102
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:
92020-4520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-444-2191
Provider Business Practice Location Address Fax Number:
619-444-3531
Provider Enumeration Date:
08/29/2006