Provider First Line Business Practice Location Address:
5998 ALCALA PARK RM 215
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:
760-450-8731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2022