Provider First Line Business Practice Location Address:
1357 BROADWAY STE 100
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:
92021-5811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-588-1989
Provider Business Practice Location Address Fax Number:
619-588-6282
Provider Enumeration Date:
11/07/2007