Provider First Line Business Practice Location Address:
7474 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-7420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-741-8147
Provider Business Practice Location Address Fax Number:
619-741-8139
Provider Enumeration Date:
01/25/2016