Provider First Line Business Practice Location Address:
10065 OLD GROVE RD STE 102
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:
92131-1664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-387-8386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2020