Provider First Line Business Practice Location Address:
9715 MISSION GORGE RD
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:
92071-3809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-448-7444
Provider Business Practice Location Address Fax Number:
619-448-7147
Provider Enumeration Date:
08/04/2006