Provider First Line Business Practice Location Address:
8694 LAKE MURRAY BLVD
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:
92119-2828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-460-5978
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2022