Provider First Line Business Practice Location Address:
1997 FRIENDSHIP DR
Provider Second Line Business Practice Location Address:
SUITE 'C'
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-258-9902
Provider Business Practice Location Address Fax Number:
619-258-9904
Provider Enumeration Date:
05/19/2008