Provider First Line Business Practice Location Address:
12107 CALLADO RD
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:
92128-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-539-9173
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2021