Provider First Line Business Practice Location Address:
4939 DIRECTORS PL
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:
92121-3829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-203-4100
Provider Business Practice Location Address Fax Number:
858-203-4028
Provider Enumeration Date:
01/15/2021