Provider First Line Business Practice Location Address:
9845 ERMA RD STE 203
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:
92131-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-473-7874
Provider Business Practice Location Address Fax Number:
877-249-0860
Provider Enumeration Date:
11/18/2025