Provider First Line Business Practice Location Address:
255 W WASHINGTON AVE
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:
92020-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-444-7454
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2006