Provider First Line Business Practice Location Address:
6760 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 210-1
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-5827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-855-5113
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2020