Provider First Line Business Practice Location Address:
4640 CASS ST UNIT 90924
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:
92169-7118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-940-4345
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2023