Provider First Line Business Practice Location Address:
6345 EL CAJON BLVD UNIT 3301
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:
92115-5573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-717-0993
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2026