Provider First Line Business Practice Location Address:
8770 CUYAMACA ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-4282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-449-6555
Provider Business Practice Location Address Fax Number:
619-258-8819
Provider Enumeration Date:
11/17/2010