Provider First Line Business Practice Location Address:
4100 NORMAL ST
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:
92103-2653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-271-9494
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2022