Provider First Line Business Practice Location Address:
8929 COMPLEX DR STE 7-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:
92123-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-365-5603
Provider Business Practice Location Address Fax Number:
858-408-3099
Provider Enumeration Date:
08/29/2024