Provider First Line Business Practice Location Address:
892 27TH STREET SAN DIEGO, CA 92154
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO, CA 92154
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92154-9191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-316-8211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2023