Provider First Line Business Practice Location Address:
5471 KEARNY VILLA RD STE 201
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:
92123-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-987-7888
Provider Business Practice Location Address Fax Number:
619-299-6222
Provider Enumeration Date:
02/02/2017