Provider First Line Business Practice Location Address:
1885 NATIONAL AVE
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:
92113-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-330-0360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2024