Provider First Line Business Practice Location Address:
9510 CUYAMACA ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-2686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-449-6009
Provider Business Practice Location Address Fax Number:
619-449-1460
Provider Enumeration Date:
01/08/2007