Provider First Line Business Practice Location Address:
5998 ALCALA PARK RM 129
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:
92110-8001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-673-2814
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2021