Provider First Line Business Practice Location Address:
1450 COLUMBIA ST 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:
92101-3487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-452-3522
Provider Business Practice Location Address Fax Number:
646-934-6409
Provider Enumeration Date:
11/04/2020