Provider First Line Business Practice Location Address:
4283 EL CAJON BLVD STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-521-1743
Provider Business Practice Location Address Fax Number:
619-521-1896
Provider Enumeration Date:
03/29/2021