Provider First Line Business Practice Location Address:
8701 CUYAMACA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-568-8222
Provider Business Practice Location Address Fax Number:
619-568-8089
Provider Enumeration Date:
11/01/2006