Provider First Line Business Practice Location Address:
3751 BANCROFT ST
Provider Second Line Business Practice Location Address:
# 3
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-3756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-732-1121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2017