Provider First Line Business Practice Location Address:
1455 FRAZEE RD STE 544
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:
92108-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-326-9966
Provider Business Practice Location Address Fax Number:
619-923-3921
Provider Enumeration Date:
05/16/2023