Provider First Line Business Practice Location Address:
7151 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
STE. J
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-1819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-466-5858
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2010