Provider First Line Business Practice Location Address:
9125 TRUMAN 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:
92129-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-917-6012
Provider Business Practice Location Address Fax Number:
520-844-3335
Provider Enumeration Date:
01/22/2022