Provider First Line Business Practice Location Address:
757 BROADWAY
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:
92021-4631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-0322
Provider Business Practice Location Address Fax Number:
619-287-2643
Provider Enumeration Date:
12/27/2006