Provider First Line Business Practice Location Address:
15260 AMALIA ST
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:
92129-1228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-366-8787
Provider Business Practice Location Address Fax Number:
858-240-6200
Provider Enumeration Date:
07/22/2016