Provider First Line Business Practice Location Address:
353 E PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-3988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-334-4294
Provider Business Practice Location Address Fax Number:
619-334-4296
Provider Enumeration Date:
03/06/2012