Provider First Line Business Practice Location Address:
9452 MEDICAL CENTER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 1 EAST 312
Provider Business Practice Location Address City Name:
LA JULLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-0897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-534-2555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2020