Provider First Line Business Practice Location Address:
3341 BROWNING 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:
92106-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-223-4518
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2020