Provider First Line Business Practice Location Address:
8899 UNIVERSITY CENTER LN STE 305A
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:
92122-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-453-4441
Provider Business Practice Location Address Fax Number:
858-623-8519
Provider Enumeration Date:
09/23/2020