Provider First Line Business Practice Location Address:
1625 E MAIN ST STE 201
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:
92021-5244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-593-1212
Provider Business Practice Location Address Fax Number:
619-442-9956
Provider Enumeration Date:
09/17/2006