Provider First Line Business Practice Location Address:
6425 UNIVERSITY AVE
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:
92115-5808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-983-2222
Provider Business Practice Location Address Fax Number:
760-983-2410
Provider Enumeration Date:
08/17/2026