Provider First Line Business Practice Location Address:
4060 FAIRMOUNT AVE 3RD FLOOR
Provider Second Line Business Practice Location Address:
DENTAL DEPARTMENT
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-9210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-564-7018
Provider Business Practice Location Address Fax Number:
619-795-9848
Provider Enumeration Date:
05/27/2021