Provider First Line Business Practice Location Address:
9745 PROSPECT AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-448-4841
Provider Business Practice Location Address Fax Number:
619-448-8700
Provider Enumeration Date:
09/22/2006