Provider First Line Business Practice Location Address:
236 JAMACHA RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-2366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-670-7500
Provider Business Practice Location Address Fax Number:
619-593-7171
Provider Enumeration Date:
11/21/2006