Provider First Line Business Practice Location Address:
3080 N PARK WAY
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:
92104-3625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-294-6616
Provider Business Practice Location Address Fax Number:
619-294-6618
Provider Enumeration Date:
12/17/2021