Provider First Line Business Practice Location Address:
9325 MISSION GORGE RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-3881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-704-2248
Provider Business Practice Location Address Fax Number:
858-795-1195
Provider Enumeration Date:
08/15/2023