Provider First Line Business Practice Location Address:
1201 S ORANGE 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:
92020-7521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-441-1918
Provider Business Practice Location Address Fax Number:
619-441-7416
Provider Enumeration Date:
10/16/2013