Provider First Line Business Practice Location Address:
10355 SCIENCE CENTER DR
Provider Second Line Business Practice Location Address:
STE 240
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-461-6338
Provider Business Practice Location Address Fax Number:
866-770-4905
Provider Enumeration Date:
05/14/2021