Provider First Line Business Practice Location Address:
151 CLAYDELLE 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:
92020-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-442-0245
Provider Business Practice Location Address Fax Number:
619-442-3631
Provider Enumeration Date:
08/21/2006