Provider First Line Business Practice Location Address:
4090 EL CAJON BLVD STE F
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:
92105-1168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-280-0337
Provider Business Practice Location Address Fax Number:
619-280-0347
Provider Enumeration Date:
07/19/2006