Provider First Line Business Practice Location Address:
4323 LANDIS 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:
92105-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-859-5561
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2025