Provider First Line Business Practice Location Address:
3990 OLD TOWN AVE STE 205
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:
92110-2930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-867-0603
Provider Business Practice Location Address Fax Number:
619-294-9405
Provider Enumeration Date:
07/30/2024