Provider First Line Business Practice Location Address:
229 E MAIN ST
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:
92020-3911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-342-1001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2012