Provider First Line Business Practice Location Address:
4370 PALM AVE STE C
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:
92154-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-428-8682
Provider Business Practice Location Address Fax Number:
619-428-1043
Provider Enumeration Date:
12/05/2017