Provider First Line Business Practice Location Address:
3177 OCEAN VIEW BLVD
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:
92113-1432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-595-4400
Provider Business Practice Location Address Fax Number:
619-535-7927
Provider Enumeration Date:
04/15/2022