Provider First Line Business Practice Location Address:
3365 ROSECRANS ST 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:
92110-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-222-6000
Provider Business Practice Location Address Fax Number:
619-923-3627
Provider Enumeration Date:
01/30/2020