Provider First Line Business Practice Location Address:
10201 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
2ND FLOOR, SUITE N, ROOM P2
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-486-1532
Provider Business Practice Location Address Fax Number:
619-860-8661
Provider Enumeration Date:
07/30/2020