Provider First Line Business Practice Location Address:
9333 GENESEE AVE STE 310
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:
92121-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-657-6028
Provider Business Practice Location Address Fax Number:
858-249-2519
Provider Enumeration Date:
02/08/2024