Provider First Line Business Practice Location Address:
2990 JAMACHA RD
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-4376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-670-5133
Provider Business Practice Location Address Fax Number:
619-670-1492
Provider Enumeration Date:
07/29/2006