Provider First Line Business Practice Location Address:
12853 EL CAMINO REAL STE 205
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:
92130-2969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-751-2221
Provider Business Practice Location Address Fax Number:
858-751-2229
Provider Enumeration Date:
02/18/2022