Provider First Line Business Practice Location Address:
AREA OF SAN DIEGO COUNTY
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:
92109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-480-1009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2021