Provider First Line Business Practice Location Address:
11772 SORRENTO VALLEY RD STE 100
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:
92121-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-221-4229
Provider Business Practice Location Address Fax Number:
858-345-4828
Provider Enumeration Date:
02/10/2020