Provider First Line Business Practice Location Address:
3838 CAMINO DEL RIO N
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:
92108-1741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-356-3369
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2025