Provider First Line Business Practice Location Address:
4114 CAMINO DE LA PLZ APT 19C
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:
92173-2965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-751-2744
Provider Business Practice Location Address Fax Number:
619-751-2744
Provider Enumeration Date:
03/06/2026