Provider First Line Business Practice Location Address:
260 EAST CHASE AVENUE
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-6325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-235-1443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2014