Provider First Line Business Practice Location Address:
13745 BASSMORE DR
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:
92129-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-602-2985
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2023