Provider First Line Business Practice Location Address:
2260 CALLAGAN HIGHWAY BLDG 3187A STE 1
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:
92136-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-544-2231
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2021