Provider First Line Business Practice Location Address:
4575 EL CAJON BLVD.
Provider Second Line Business Practice Location Address:
STE#C
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-280-0199
Provider Business Practice Location Address Fax Number:
619-280-0089
Provider Enumeration Date:
12/08/2005