Provider First Line Business Practice Location Address:
800 W IVY ST STE A
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:
92101-1771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-840-6700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2019