Provider First Line Business Practice Location Address:
1901 1ST AVE STE 124
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:
92101-0300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-550-4010
Provider Business Practice Location Address Fax Number:
619-269-8796
Provider Enumeration Date:
04/10/2022