Provider First Line Business Practice Location Address:
720 GATEWAY CENTER DR STE C
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:
92102-4549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-373-3533
Provider Business Practice Location Address Fax Number:
619-919-0023
Provider Enumeration Date:
08/13/2024