Provider First Line Business Practice Location Address:
6551 MALCOLM DR
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:
92115-5935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-252-5254
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2023