Provider First Line Business Practice Location Address:
2335 CHATSWORTH BLVD
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:
92106-1646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-603-4768
Provider Business Practice Location Address Fax Number:
202-603-4768
Provider Enumeration Date:
04/11/2023