Provider First Line Business Practice Location Address:
4660 EL CAJON BLVD STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-884-0232
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2026