Provider First Line Business Practice Location Address:
7220 TRADE ST STE 245
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:
92121-2324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-327-3033
Provider Business Practice Location Address Fax Number:
858-327-3998
Provider Enumeration Date:
06/29/2020