Provider First Line Business Practice Location Address:
4616 EL CAJAN BLVD
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-563-0567
Provider Business Practice Location Address Fax Number:
619-563-0568
Provider Enumeration Date:
10/23/2006