Provider First Line Business Practice Location Address:
13430 EL PRESIDIO TRL
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:
92130-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-245-5003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2022