Provider First Line Business Practice Location Address:
1835 EL CAJON BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-688-9000
Provider Business Practice Location Address Fax Number:
619-692-4160
Provider Enumeration Date:
02/15/2007