Provider First Line Business Practice Location Address:
2593 MANZANA WAY
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:
92139-4068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-312-8253
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2019