Provider First Line Business Practice Location Address:
5454 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-3621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-515-2400
Provider Business Practice Location Address Fax Number:
619-906-4564
Provider Enumeration Date:
06/30/2014