Provider First Line Business Practice Location Address:
7364 EL CAJON BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 212
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-203-9326
Provider Business Practice Location Address Fax Number:
619-741-8549
Provider Enumeration Date:
04/24/2007