Provider First Line Business Practice Location Address:
5442 DEHESA RD
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:
92019-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-445-3518
Provider Business Practice Location Address Fax Number:
619-445-5814
Provider Enumeration Date:
03/09/2007