Provider First Line Business Practice Location Address:
1031 25TH ST # 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:
92102-2194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-772-3210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2023