Provider First Line Business Practice Location Address:
1136 N 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92021-5008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-444-1181
Provider Business Practice Location Address Fax Number:
619-444-4552
Provider Enumeration Date:
08/02/2005