Provider First Line Business Practice Location Address:
7425 LA MANTANZA
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:
92127-3636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-429-5493
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2020