Provider First Line Business Practice Location Address:
9565 WAPLES ST STE 100
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:
92121-2973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-375-5454
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2023