Provider First Line Business Practice Location Address:
10981 SAN DIEGO MISSION RD STE 112
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:
92108-2448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-693-7399
Provider Business Practice Location Address Fax Number:
877-887-9814
Provider Enumeration Date:
10/17/2017