Provider First Line Business Practice Location Address:
5252 ORANGE AVE UNIT 322
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:
92115-6034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-801-2319
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2022