Provider First Line Business Practice Location Address:
5011 HOLLY DR 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:
92113-2047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-292-9490
Provider Business Practice Location Address Fax Number:
619-915-6892
Provider Enumeration Date:
07/02/2024