Provider First Line Business Practice Location Address:
2990 JAMACHA RD STE 240
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:
92019-4386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-630-7793
Provider Business Practice Location Address Fax Number:
619-923-2773
Provider Enumeration Date:
11/01/2023