Provider First Line Business Practice Location Address:
2990 JAMACHA RD
Provider Second Line Business Practice Location Address:
SUITE 132
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-4376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-670-1700
Provider Business Practice Location Address Fax Number:
619-670-4690
Provider Enumeration Date:
11/20/2006