Provider First Line Business Practice Location Address:
34101 FAREHOLT AVE 92134 BUILDING 14
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:
92134-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-659-1395
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2021