Provider First Line Business Practice Location Address:
770 1ST AVE
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:
92101-6169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-927-6116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2024