Provider First Line Business Practice Location Address:
6663 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE # C-D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-2848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-337-8005
Provider Business Practice Location Address Fax Number:
619-337-8006
Provider Enumeration Date:
03/29/2007