Provider First Line Business Practice Location Address:
4974 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-286-4600
Provider Business Practice Location Address Fax Number:
619-286-0060
Provider Enumeration Date:
01/21/2010