Provider First Line Business Practice Location Address:
4712 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:
92115-4557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-563-0724
Provider Business Practice Location Address Fax Number:
619-563-5287
Provider Enumeration Date:
08/21/2006