Provider First Line Business Practice Location Address:
1465 E MADISON AVENUE
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:
92019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-440-4591
Provider Business Practice Location Address Fax Number:
619-440-4944
Provider Enumeration Date:
12/02/2008