Provider First Line Business Practice Location Address:
6434 JOUGLARD 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:
92114-6930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-327-0429
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2026