Provider First Line Business Practice Location Address:
5405 MOREHOUSE DR STE 120
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:
92121-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-458-5909
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2016