Provider First Line Business Practice Location Address:
3638 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-220-0548
Provider Business Practice Location Address Fax Number:
619-220-8604
Provider Enumeration Date:
01/09/2007