Provider First Line Business Practice Location Address:
9327 LAKE MURRAY BLVD UNIT E
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:
92119-1462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-838-1145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2026