Provider First Line Business Practice Location Address:
8426 FIRESIDE 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:
92123-2848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-337-4969
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2024