Provider First Line Business Practice Location Address:
7339 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-3435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-698-0606
Provider Business Practice Location Address Fax Number:
619-698-0609
Provider Enumeration Date:
05/09/2006