Provider First Line Business Practice Location Address:
10727 SANTA TOMASA 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:
92127-3309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-371-2359
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2025