Provider First Line Business Practice Location Address:
1530 PALM 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:
92154-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-343-0095
Provider Business Practice Location Address Fax Number:
619-830-4590
Provider Enumeration Date:
02/08/2024