Provider First Line Business Practice Location Address:
5078 MANOR RIDGE LN
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:
92130-2896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-630-8940
Provider Business Practice Location Address Fax Number:
949-239-7799
Provider Enumeration Date:
10/02/2024