Provider First Line Business Practice Location Address:
1963 4TH 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:
92101-2394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-233-3432
Provider Business Practice Location Address Fax Number:
619-233-7022
Provider Enumeration Date:
03/12/2024