Provider First Line Business Practice Location Address:
8760 CUYAMACA ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-6210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-258-1011
Provider Business Practice Location Address Fax Number:
619-258-1023
Provider Enumeration Date:
11/20/2006