Provider First Line Business Practice Location Address:
6696 MESA RIDGE RD STE B
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:
92121-2950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-344-7993
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2021