Provider First Line Business Practice Location Address:
2005 EBERS 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:
92107-2227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-476-2061
Provider Business Practice Location Address Fax Number:
202-476-2187
Provider Enumeration Date:
11/30/2020