Provider First Line Business Practice Location Address:
2305 HISTORIC DECATUR RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92106-6050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-930-5458
Provider Business Practice Location Address Fax Number:
888-972-5316
Provider Enumeration Date:
08/04/2015