Provider First Line Business Practice Location Address:
2650 JAMACHA RD
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-4319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-670-6296
Provider Business Practice Location Address Fax Number:
619-670-8852
Provider Enumeration Date:
04/19/2010