Provider First Line Business Practice Location Address:
3353 LA JUNTA 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:
92117-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-685-6009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2021