Provider First Line Business Practice Location Address:
8790 CUYAMACA ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-4295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-562-4327
Provider Business Practice Location Address Fax Number:
619-562-4427
Provider Enumeration Date:
02/25/2011