Provider First Line Business Practice Location Address:
6402 LINDA VISTA RD
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:
92111-7320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-1304
Provider Business Practice Location Address Fax Number:
858-292-1328
Provider Enumeration Date:
03/21/2023