Provider First Line Business Practice Location Address:
615 E LEXINGTON 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:
92020-4617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-962-6748
Provider Business Practice Location Address Fax Number:
619-588-9747
Provider Enumeration Date:
08/31/2006