Provider First Line Business Practice Location Address:
2140 HARTFORD ST
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:
92110-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-877-3422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2019