Provider First Line Business Practice Location Address:
230 N MOLLISON AVENUE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-673-9074
Provider Business Practice Location Address Fax Number:
619-673-9075
Provider Enumeration Date:
09/03/2026