Provider First Line Business Practice Location Address:
1340 BOSWORTH ST
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:
92019-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-588-5843
Provider Business Practice Location Address Fax Number:
619-588-5843
Provider Enumeration Date:
01/22/2024