Provider First Line Business Practice Location Address:
3426 COLLEGE AVE # 152943
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:
92115-7134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-264-6848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2026