Provider First Line Business Practice Location Address:
1242 - EAST MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-689-9846
Provider Business Practice Location Address Fax Number:
858-689-0131
Provider Enumeration Date:
02/21/2007