Provider First Line Business Practice Location Address:
3491 KURTZ ST STE 150
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:
92110-4430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-320-2404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2022