Provider First Line Business Practice Location Address:
4305 UNIVERSITY AVENUE, SUITE 150
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:
92105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-966-5484
Provider Business Practice Location Address Fax Number:
858-966-5484
Provider Enumeration Date:
02/02/2017