Provider First Line Business Practice Location Address:
5530 OVERLAND AVE
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:
92123-1260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-528-4000
Provider Business Practice Location Address Fax Number:
858-514-6514
Provider Enumeration Date:
12/09/2019