Provider First Line Business Practice Location Address:
1530 JAMACHA ROAD
Provider Second Line Business Practice Location Address:
UNIT E UNIT F
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-441-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2006