Provider First Line Business Practice Location Address:
5252 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-901-4200
Provider Business Practice Location Address Fax Number:
714-903-9425
Provider Enumeration Date:
08/20/2007