Provider First Line Business Practice Location Address:
8929 UNIVERSITY CENTER LN STE 208
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:
92122-1054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-625-0809
Provider Business Practice Location Address Fax Number:
858-625-0835
Provider Enumeration Date:
11/21/2018