Provider First Line Business Practice Location Address:
6402 EL CAJON BLVD STE 100
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:
92115-2645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-582-4490
Provider Business Practice Location Address Fax Number:
619-582-4737
Provider Enumeration Date:
04/03/2025