Provider First Line Business Practice Location Address:
560 BROCKTON ST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-461-7776
Provider Business Practice Location Address Fax Number:
619-461-5641
Provider Enumeration Date:
12/14/2006