Provider First Line Business Practice Location Address:
3770 TANSY ST STE 101A
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:
92121-1550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-314-5883
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2023