Provider First Line Business Practice Location Address:
5330 CARROLL CANYON RD STE 140
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:
92121-3758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-295-0501
Provider Business Practice Location Address Fax Number:
308-646-6140
Provider Enumeration Date:
01/02/2024