Provider First Line Business Practice Location Address:
1527 E MAIN ST
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:
92021-5902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-303-4181
Provider Business Practice Location Address Fax Number:
619-330-4959
Provider Enumeration Date:
09/28/2026