Provider First Line Business Practice Location Address:
6244 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:
92115-3918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-326-0606
Provider Business Practice Location Address Fax Number:
619-326-0626
Provider Enumeration Date:
10/02/2009