Provider First Line Business Practice Location Address:
436 S MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-5219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-631-7400
Provider Business Practice Location Address Fax Number:
619-631-7402
Provider Enumeration Date:
09/29/2011