Provider First Line Business Practice Location Address:
9450 SCRANTON RD STE 109
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:
92121-4742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-457-8514
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2020