Provider First Line Business Practice Location Address:
6612 MISSION GORGE RD STE B
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:
92120-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-226-2113
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2022