Provider First Line Business Practice Location Address:
1806 CABLE ST
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:
92107-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-226-4784
Provider Business Practice Location Address Fax Number:
619-226-3027
Provider Enumeration Date:
05/06/2021