Provider First Line Business Practice Location Address:
9560 CANDIDA 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:
92126-4540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-345-6835
Provider Business Practice Location Address Fax Number:
760-546-2242
Provider Enumeration Date:
05/25/2017