Provider First Line Business Practice Location Address:
2869 HISTORIC DECATUR RD
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:
92106-6176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-291-0036
Provider Business Practice Location Address Fax Number:
858-724-3655
Provider Enumeration Date:
09/02/2025