Provider First Line Business Practice Location Address:
366 S PIERCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-334-8880
Provider Business Practice Location Address Fax Number:
619-334-8885
Provider Enumeration Date:
12/12/2006