Provider First Line Business Practice Location Address:
5405 MOREHOUSE DR
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-826-1350
Provider Business Practice Location Address Fax Number:
858-408-9422
Provider Enumeration Date:
06/29/2016