Provider First Line Business Practice Location Address:
11650 IBERIA PL STE 135
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:
92128-2456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-708-8564
Provider Business Practice Location Address Fax Number:
619-764-4020
Provider Enumeration Date:
08/27/2024