Provider First Line Business Practice Location Address:
3180 UNIVERSITY AVE STE 120
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:
92104-2046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-529-7229
Provider Business Practice Location Address Fax Number:
858-795-1195
Provider Enumeration Date:
07/26/2018