Provider First Line Business Practice Location Address:
14374 OLD CREEK RD
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:
92131-4274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-977-9295
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2025