Provider First Line Business Practice Location Address:
2376 SOTO ST
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:
92107-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-803-6018
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2020