Provider First Line Business Practice Location Address:
682 S JOHNSON 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:
92020-4941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-375-8627
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2025