Provider First Line Business Practice Location Address:
525 W BRADLEY AVE
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:
92020-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-937-2330
Provider Business Practice Location Address Fax Number:
619-937-2338
Provider Enumeration Date:
07/01/2020