Provider First Line Business Practice Location Address:
1227 BOSTONIA ST
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:
92021-5019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-238-7128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2023