Provider First Line Business Practice Location Address:
1916 SOUTH 43RD 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:
92113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-538-7599
Provider Business Practice Location Address Fax Number:
619-393-0448
Provider Enumeration Date:
01/12/2022