Provider First Line Business Practice Location Address:
10670 JOHN J HOPKINS DR
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:
92121-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-554-8640
Provider Business Practice Location Address Fax Number:
858-554-9383
Provider Enumeration Date:
07/08/2019