Provider First Line Business Practice Location Address:
327 NORTHGATE 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:
92114-7140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-820-0040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2024