Provider First Line Business Practice Location Address:
794 DOROTHY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-444-8270
Provider Business Practice Location Address Fax Number:
619-444-0872
Provider Enumeration Date:
08/24/2006