Provider First Line Business Practice Location Address:
4153B UNIVERSITY AVE, SUITE B
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:
92105-1421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-590-0056
Provider Business Practice Location Address Fax Number:
619-333-2525
Provider Enumeration Date:
04/28/2021