Provider First Line Business Practice Location Address:
4283 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-521-1743
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2012