Provider First Line Business Practice Location Address:
4444 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-241-8555
Provider Business Practice Location Address Fax Number:
619-241-8525
Provider Enumeration Date:
08/31/2011