Provider First Line Business Practice Location Address:
5752 OBERLIN DR
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-993-5547
Provider Business Practice Location Address Fax Number:
760-529-9444
Provider Enumeration Date:
05/14/2016