Provider First Line Business Practice Location Address:
14291 RIOS CANYON RD SPC 30
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:
92021-2722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-945-7545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2025