Provider First Line Business Practice Location Address:
1365 N JOHNSON AVE
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-1676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-440-4801
Provider Business Practice Location Address Fax Number:
619-442-1592
Provider Enumeration Date:
07/03/2015