Provider First Line Business Practice Location Address:
9909 HUENNEKENS ST STE 110
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:
92121-2928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-669-3295
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2025