Provider First Line Business Practice Location Address:
5030 LAKIBA PALMER 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:
92102-3746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-943-0162
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2022