Provider First Line Business Practice Location Address:
4431 32ND ST UNIT 12
Provider Second Line Business Practice Location Address:
UNIT #12
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92116-4575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-685-2268
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2015