Provider First Line Business Practice Location Address:
4283 EL CAJON BLVD STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-241-3841
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2019