Provider First Line Business Practice Location Address:
222 W MADISON AVE
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:
92020-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-579-5115
Provider Business Practice Location Address Fax Number:
619-749-6174
Provider Enumeration Date:
10/26/2007