Provider First Line Business Practice Location Address:
5504 1/2 UNIVERSITY AVE
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:
92105-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-467-6834
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2021