Provider First Line Business Practice Location Address:
300 S PIERCE ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-589-6888
Provider Business Practice Location Address Fax Number:
619-589-6492
Provider Enumeration Date:
05/11/2007