Provider First Line Business Practice Location Address:
5353 AIRWAY 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:
92154-4806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-691-1045
Provider Business Practice Location Address Fax Number:
619-662-1153
Provider Enumeration Date:
06/07/2022