Provider First Line Business Practice Location Address:
4320 TRIAS ST
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:
92103-1127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-888-5332
Provider Business Practice Location Address Fax Number:
858-300-5197
Provider Enumeration Date:
04/14/2023