Provider First Line Business Practice Location Address:
13727 CAMINO CANADA
Provider Second Line Business Practice Location Address:
SUITE A4
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92021-8847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-938-1800
Provider Business Practice Location Address Fax Number:
619-938-1888
Provider Enumeration Date:
02/02/2009