Provider First Line Business Practice Location Address:
5033 SEACHASE 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:
92130-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-947-5722
Provider Business Practice Location Address Fax Number:
888-850-3455
Provider Enumeration Date:
06/13/2018