Provider First Line Business Practice Location Address:
8770 CUYAMACA ST STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-4289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-596-9890
Provider Business Practice Location Address Fax Number:
619-596-9893
Provider Enumeration Date:
10/03/2006