Provider First Line Business Practice Location Address:
10755 SCRIPPS POWAY PKWY # 126
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:
92131-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-220-6899
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2025