Provider First Line Business Practice Location Address:
175 W LEXINGTON AVE STE B
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:
92020-4454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-445-2814
Provider Business Practice Location Address Fax Number:
619-923-5881
Provider Enumeration Date:
05/28/2020