Provider First Line Business Practice Location Address:
5638 MISSION CENTER RD STE 107
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:
92108-4348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-220-0159
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2023