Provider First Line Business Practice Location Address:
9909 HUENNEKENS ST STE 110
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:
92121-2928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-500-8000
Provider Business Practice Location Address Fax Number:
858-864-1429
Provider Enumeration Date:
08/03/2026