Provider First Line Business Practice Location Address:
7917 OSTROW ST STE A
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:
92111-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-300-8282
Provider Business Practice Location Address Fax Number:
858-300-8284
Provider Enumeration Date:
08/08/2022