Provider First Line Business Practice Location Address:
3788 PARK BLVD STE 5
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:
92103-0912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-683-2020
Provider Business Practice Location Address Fax Number:
619-683-2111
Provider Enumeration Date:
01/23/2024