Provider First Line Business Practice Location Address:
3055 UNIVERSITY AVE STE 113
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:
92104-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-703-7757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2026