Provider First Line Business Practice Location Address:
3601 MOUNT ALADIN AVE
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:
92111-4036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-518-4956
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2017