Provider First Line Business Practice Location Address:
3726 NARRAGANSETT AVE
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:
92107-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-787-3001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/24/2017