Provider First Line Business Practice Location Address:
291 E LEXINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-4536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-442-6600
Provider Business Practice Location Address Fax Number:
619-442-6601
Provider Enumeration Date:
02/15/2013