Provider First Line Business Practice Location Address:
860 JAMACHA ROAD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-3225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-456-9920
Provider Business Practice Location Address Fax Number:
619-456-9340
Provider Enumeration Date:
07/29/2015