Provider First Line Business Practice Location Address:
9474 KEARNY VILLA RD STE 101
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:
92126-4596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-310-9888
Provider Business Practice Location Address Fax Number:
858-310-0020
Provider Enumeration Date:
10/29/2024