Provider First Line Business Practice Location Address:
SUD SPECIALTY GROUP-CA
Provider Second Line Business Practice Location Address:
11838 BERNARDO PLAZA CT STE 250
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-4159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-410-6614
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2020