Provider First Line Business Practice Location Address:
3491 KURTZ 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:
92110-4430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-729-2316
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2020