Provider First Line Business Practice Location Address:
2950 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-945-3350
Provider Business Practice Location Address Fax Number:
310-840-7023
Provider Enumeration Date:
11/29/2012