Provider First Line Business Practice Location Address:
13436 EL PRESIDIO TRL
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:
92130-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-400-9583
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2025