Provider First Line Business Practice Location Address:
6210 EL CAJON BLVD
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:
92115-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-452-2322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2026