Provider First Line Business Practice Location Address:
6766 BROOKLYN 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:
92114-2932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-219-1278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2024