Provider First Line Business Practice Location Address:
3555 ROSECRANS ST STE 107B
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:
92110-3232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-226-1877
Provider Business Practice Location Address Fax Number:
619-226-0482
Provider Enumeration Date:
06/19/2023