Provider First Line Business Practice Location Address:
4365 MEADE AVE
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:
92116-4816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-550-1491
Provider Business Practice Location Address Fax Number:
619-255-5437
Provider Enumeration Date:
11/07/2014