Provider First Line Business Practice Location Address:
1224 GREENFIELD DR BLDG 1
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:
92021-3316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-571-0976
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2012