Provider First Line Business Practice Location Address:
700 N JOHNSON AVE
Provider Second Line Business Practice Location Address:
STE F
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-2592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-318-5103
Provider Business Practice Location Address Fax Number:
619-330-0602
Provider Enumeration Date:
10/06/2014