Provider First Line Business Practice Location Address:
4444 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE #6
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-285-1522
Provider Business Practice Location Address Fax Number:
619-285-0714
Provider Enumeration Date:
11/17/2006