Provider First Line Business Practice Location Address:
4294 LANDIS ST
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:
92105-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-794-7940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2022