Provider First Line Business Practice Location Address:
200 W ARBOR DRIVE
Provider Second Line Business Practice Location Address:
MAIL CODE: 0304
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-775-5750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2026