Provider First Line Business Practice Location Address:
5735 KEARNY VILLA RD STE 101
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:
92123-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-644-2170
Provider Business Practice Location Address Fax Number:
619-644-2174
Provider Enumeration Date:
02/20/2018