Provider First Line Business Practice Location Address:
1465 30TH ST STE K
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:
92154-3497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-428-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2021