Provider First Line Business Practice Location Address:
5414 OBERLIN DR STE 230
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:
92121-4744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-281-1588
Provider Business Practice Location Address Fax Number:
858-777-1721
Provider Enumeration Date:
08/29/2023