Provider First Line Business Practice Location Address:
3401 FARENHOLT 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:
92134-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-549-6125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2018