Provider First Line Business Practice Location Address:
6202 FRIARS RD UNIT 215
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:
92108-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-941-4163
Provider Business Practice Location Address Fax Number:
530-941-4163
Provider Enumeration Date:
06/03/2017