Provider First Line Business Practice Location Address:
2821 LANGE 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:
92122-3109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-641-5366
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2022