Provider First Line Business Practice Location Address:
3033 SCIENCE PARK RD
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:
92121-1167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-430-7996
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2025