Provider First Line Business Practice Location Address:
4948 ORCUTT 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:
92120-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-756-1258
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2012