Provider First Line Business Practice Location Address:
2496 BAUER ROAD
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:
92145-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-307-1560
Provider Business Practice Location Address Fax Number:
858-307-9849
Provider Enumeration Date:
10/11/2017