Provider First Line Business Practice Location Address:
6209 LAKE APOPKA PL
Provider Second Line Business Practice Location Address:
6209 LAKE APOPKA PLACE
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92119-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
161-989-0392
Provider Business Practice Location Address Fax Number:
161-940-4418
Provider Enumeration Date:
12/04/2015