Provider First Line Business Practice Location Address:
416 S MAGNOLIA AVE STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-5213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-663-1521
Provider Business Practice Location Address Fax Number:
619-749-7822
Provider Enumeration Date:
09/19/2009