Provider First Line Business Practice Location Address:
550 FESLER ST
Provider Second Line Business Practice Location Address:
SUITE G3
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-1959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-588-5361
Provider Business Practice Location Address Fax Number:
619-588-5421
Provider Enumeration Date:
06/24/2011