Provider First Line Business Practice Location Address:
1670 GARNET AVENUE
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:
92109-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-270-1163
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2016