Provider First Line Business Practice Location Address:
6160 MISSION GORGE RD
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:
92120-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
194-813-7906
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2019