Provider First Line Business Practice Location Address:
7532 RADENZ AVE
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:
92111-5821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-304-6773
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2026