Provider First Line Business Practice Location Address:
6255 UNIVERSITY AVE STE A1
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:
92115-5727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-436-5571
Provider Business Practice Location Address Fax Number:
619-436-5572
Provider Enumeration Date:
12/03/2019