Provider First Line Business Practice Location Address:
3767 CENTRAL 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:
92105-2599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-584-4010
Provider Business Practice Location Address Fax Number:
619-278-0770
Provider Enumeration Date:
11/30/2022