Provider First Line Business Practice Location Address:
2180 GARNET AVE
Provider Second Line Business Practice Location Address:
SUITE 1I
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-432-2477
Provider Business Practice Location Address Fax Number:
619-839-3620
Provider Enumeration Date:
10/28/2021