Provider First Line Business Practice Location Address:
1365 AND 1385 N JOHNSON AVE
Provider Second Line Business Practice Location Address:
SUITES 111, 112, 113, 102, 103, AND 104
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-1649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-440-4801
Provider Business Practice Location Address Fax Number:
619-442-1592
Provider Enumeration Date:
05/01/2007