Provider First Line Business Practice Location Address:
11722 SORRENTO VALLEY RD STE A
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:
92121-1021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-829-0220
Provider Business Practice Location Address Fax Number:
619-250-0028
Provider Enumeration Date:
07/15/2021