Provider First Line Business Practice Location Address:
9235 ACTIVITY RD STE 108
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:
92126-4440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-564-8398
Provider Business Practice Location Address Fax Number:
858-408-3419
Provider Enumeration Date:
03/01/2021