Provider First Line Business Practice Location Address:
1135 AVOCADO AVE
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:
92020-7702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-447-2332
Provider Business Practice Location Address Fax Number:
619-447-6033
Provider Enumeration Date:
06/10/2010