Provider First Line Business Practice Location Address:
771 JAMACHA RD (NO OFFICE - HOUSECALLS ONLY)
Provider Second Line Business Practice Location Address:
#257
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-3202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-272-4222
Provider Business Practice Location Address Fax Number:
619-272-4222
Provider Enumeration Date:
06/30/2010