Provider First Line Business Practice Location Address:
5230 CARROLL CANYON RD STE 218
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:
92121-1780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-344-0111
Provider Business Practice Location Address Fax Number:
619-433-6790
Provider Enumeration Date:
01/08/2018