Provider First Line Business Practice Location Address:
1771 HISTORIC DECATUR 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:
92106-6410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-277-3978
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2021