Provider First Line Business Practice Location Address:
2445 BROADWAY
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:
92102-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-468-5700
Provider Business Practice Location Address Fax Number:
619-468-5701
Provider Enumeration Date:
04/10/2021