Provider First Line Business Practice Location Address:
2214 LINWOOD 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:
92110-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-540-8544
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2024