Provider First Line Business Practice Location Address:
4444 EL CAJON BLVD STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-563-9917
Provider Business Practice Location Address Fax Number:
619-563-2097
Provider Enumeration Date:
02/25/2007