Provider First Line Business Practice Location Address:
4153 UNIVERSITY AVE
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:
92105-1421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-333-2266
Provider Business Practice Location Address Fax Number:
619-333-2270
Provider Enumeration Date:
01/28/2020