Provider First Line Business Practice Location Address:
9175 MISSION GORGE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-213-2175
Provider Business Practice Location Address Fax Number:
619-449-7788
Provider Enumeration Date:
12/17/2007