Provider First Line Business Practice Location Address:
842 WASHINGTON ST STE A
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:
92103-2214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-1168
Provider Business Practice Location Address Fax Number:
619-291-3436
Provider Enumeration Date:
05/24/2021