Provider First Line Business Practice Location Address:
630 SOUTH LINCOLN AVE
Provider Second Line Business Practice Location Address:
#12
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-782-7116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2007