Provider First Line Business Practice Location Address:
5735 KEARNY VILLA RD STE 111
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:
858-598-5505
Provider Business Practice Location Address Fax Number:
858-598-5508
Provider Enumeration Date:
11/12/2020