Provider First Line Business Practice Location Address:
3490 PALM AVE
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:
92154-1664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-423-5616
Provider Business Practice Location Address Fax Number:
619-423-5684
Provider Enumeration Date:
06/14/2016