Provider First Line Business Practice Location Address:
212 NEPTUNE ST
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:
92155-5144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-934-3544
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2026