Provider First Line Business Practice Location Address:
9135 BUCKWHEAT 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:
92129-3643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-946-8738
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2015