Provider First Line Business Practice Location Address:
5442 SYCUAN RD
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:
92019-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-445-0707
Provider Business Practice Location Address Fax Number:
619-445-5179
Provider Enumeration Date:
01/29/2007