Provider First Line Business Practice Location Address:
6877 1/2 AMHERST 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:
92115-3074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-552-5552
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2016