Provider First Line Business Practice Location Address:
12798 RANCHO PENASQUITOS BLVD STE J
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:
92129-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-484-4242
Provider Business Practice Location Address Fax Number:
858-484-4002
Provider Enumeration Date:
06/20/2022