Provider First Line Business Practice Location Address:
446 ALTA 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:
92158-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-661-2789
Provider Business Practice Location Address Fax Number:
619-667-2797
Provider Enumeration Date:
08/10/2020