Provider First Line Business Practice Location Address:
5602 EL CAJON BOULEVARD
Provider Second Line Business Practice Location Address:
COLONIAL CORNER MEDICAL GROUP
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-3735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-582-5105
Provider Business Practice Location Address Fax Number:
619-582-5121
Provider Enumeration Date:
05/02/2014