Provider First Line Business Practice Location Address:
300 S. PIERCE ST
Provider Second Line Business Practice Location Address:
SUITE 201
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-334-4735
Provider Business Practice Location Address Fax Number:
619-334-4769
Provider Enumeration Date:
11/23/2011