Provider First Line Business Practice Location Address:
5018 1/2 SANTA CRUZ 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:
92107-3312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-964-8748
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2024