Provider First Line Business Practice Location Address:
9717 MISSION GORGE RD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-420-5369
Provider Business Practice Location Address Fax Number:
760-637-5705
Provider Enumeration Date:
09/02/2018