Provider First Line Business Practice Location Address:
3620 MOUNT ABBEY 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:
92111-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-865-6737
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2023