Provider First Line Business Practice Location Address:
9535 MISSION GORGE ROAD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-562-3330
Provider Business Practice Location Address Fax Number:
619-631-7330
Provider Enumeration Date:
05/02/2007