Provider First Line Business Practice Location Address:
9815 CARROLL CANYON RD STE 101
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:
92131-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-333-1082
Provider Business Practice Location Address Fax Number:
858-571-1799
Provider Enumeration Date:
02/06/2020