Provider First Line Business Practice Location Address:
11878 AVENUE OF INDUSTRY
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:
92128-3423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-320-8070
Provider Business Practice Location Address Fax Number:
930-222-3073
Provider Enumeration Date:
10/03/2023