Provider First Line Business Practice Location Address:
426 E CHASE 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:
92020-6409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-447-1069
Provider Business Practice Location Address Fax Number:
619-447-4629
Provider Enumeration Date:
05/10/2019