Provider First Line Business Practice Location Address:
5473 KEARNY VILLA RD STE 300
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:
92123-1142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-285-0979
Provider Business Practice Location Address Fax Number:
619-881-8079
Provider Enumeration Date:
09/30/2021