Provider First Line Business Practice Location Address:
10765 WOODSIDE AVE;
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-370-3143
Provider Business Practice Location Address Fax Number:
619-448-0132
Provider Enumeration Date:
02/01/2007