Provider First Line Business Practice Location Address:
338 W LEXINGTON AVE STE 104
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:
92020-4443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-906-4527
Provider Business Practice Location Address Fax Number:
619-269-8670
Provider Enumeration Date:
05/26/2023