Provider First Line Business Practice Location Address:
3914 MURPHY CANYON RD STE A212
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:
92123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-251-4215
Provider Business Practice Location Address Fax Number:
800-650-9641
Provider Enumeration Date:
06/07/2016