Provider First Line Business Practice Location Address:
161 E MAIN ST
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:
92020-3909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-442-5400
Provider Business Practice Location Address Fax Number:
619-285-9791
Provider Enumeration Date:
07/20/2006