Provider First Line Business Practice Location Address:
1208 N 2ND 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:
92021-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-788-6810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2024