Provider First Line Business Practice Location Address:
2277 PALM AVE
Provider Second Line Business Practice Location Address:
94
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92154-4753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-382-6750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2016