Provider First Line Business Practice Location Address:
3880 ROSECRANS 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:
92110-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-515-0243
Provider Business Practice Location Address Fax Number:
619-235-0678
Provider Enumeration Date:
07/18/2018