Provider First Line Business Practice Location Address:
1804 CABLE ST STE A
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:
92107-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-601-4199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2018