Provider First Line Business Practice Location Address:
810 JAMACHA RD
Provider Second Line Business Practice Location Address:
SUITE #104
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-6218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-579-0233
Provider Business Practice Location Address Fax Number:
619-579-0691
Provider Enumeration Date:
05/16/2013