Provider First Line Business Practice Location Address:
8772 CUYAMACA ST STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-4207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-258-6730
Provider Business Practice Location Address Fax Number:
619-448-8586
Provider Enumeration Date:
10/20/2026