Provider First Line Business Practice Location Address:
3148 MIDWAY DR STE 113
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:
92110-4539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-514-5100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2023