Provider First Line Business Practice Location Address:
406 9TH AVE STE 208
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:
92101-7277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-554-8328
Provider Business Practice Location Address Fax Number:
619-780-7961
Provider Enumeration Date:
09/18/2020