Provider First Line Business Practice Location Address:
19871 MITSCHER WAY BLDG 2495
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:
92145-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-307-1824
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2023