Provider First Line Business Practice Location Address:
450 STABLERIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-1245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-462-5916
Provider Business Practice Location Address Fax Number:
619-334-1313
Provider Enumeration Date:
06/25/2006