Provider First Line Business Practice Location Address:
8760 CUYAMACA ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-6210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-258-8824
Provider Business Practice Location Address Fax Number:
619-258-9091
Provider Enumeration Date:
07/12/2006