Provider First Line Business Practice Location Address:
1940 EL CAJON BLVD
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:
92104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-543-4500
Provider Business Practice Location Address Fax Number:
619-294-2979
Provider Enumeration Date:
08/20/2009