Provider First Line Business Practice Location Address:
860 JAMACHA RD STE 203
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:
92019-3224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-442-0945
Provider Business Practice Location Address Fax Number:
619-579-5945
Provider Enumeration Date:
08/30/2006