Provider First Line Business Practice Location Address:
4585 COLLEGE AVE STE C
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:
92115-4029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-678-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2024