Provider First Line Business Practice Location Address:
270 E DOUGLAS AVE
Provider Second Line Business Practice Location Address:
STE 100A
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-4514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-6721
Provider Business Practice Location Address Fax Number:
858-279-5440
Provider Enumeration Date:
01/02/2007