Provider First Line Business Practice Location Address:
225 W MADISON AVE STE 2
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-631-4505
Provider Business Practice Location Address Fax Number:
619-713-6290
Provider Enumeration Date:
08/09/2006