Provider First Line Business Practice Location Address:
640 GARFIELD AVE UNIT 4
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:
92020-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-633-6506
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2019