Provider First Line Business Practice Location Address:
7339 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-7435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-668-1515
Provider Business Practice Location Address Fax Number:
619-668-1525
Provider Enumeration Date:
09/29/2010