Provider First Line Business Practice Location Address:
3288 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-521-5720
Provider Business Practice Location Address Fax Number:
619-521-5728
Provider Enumeration Date:
10/17/2011