Provider First Line Business Practice Location Address:
1221 EMERALD AVE # 614
Provider Second Line Business Practice Location Address:
EMERALD MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-7315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-593-7627
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2007