Provider First Line Business Practice Location Address:
4275 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:
92105-1254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-283-9624
Provider Business Practice Location Address Fax Number:
619-641-7656
Provider Enumeration Date:
05/24/2007