Provider First Line Business Practice Location Address:
322 1/2 W WASHINGTON 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:
92103-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-408-8326
Provider Business Practice Location Address Fax Number:
833-758-3828
Provider Enumeration Date:
10/05/2023