Provider First Line Business Practice Location Address:
6101 MISSION GORGE RD
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:
92120-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-272-2271
Provider Business Practice Location Address Fax Number:
619-272-4167
Provider Enumeration Date:
07/27/2022