Provider First Line Business Practice Location Address:
1530 JAMACHA RD
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-447-6464
Provider Business Practice Location Address Fax Number:
619-447-0701
Provider Enumeration Date:
12/29/2006