Provider First Line Business Practice Location Address:
1308 N. MAGNOLIA AVE.
Provider Second Line Business Practice Location Address:
STE. M
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-1675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-447-2103
Provider Business Practice Location Address Fax Number:
619-447-3435
Provider Enumeration Date:
09/10/2007