Provider First Line Business Practice Location Address:
13242 ENTREKEN 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:
92129-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-425-2737
Provider Business Practice Location Address Fax Number:
619-425-5869
Provider Enumeration Date:
11/21/2015