Provider First Line Business Practice Location Address:
4101 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:
92105-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-849-7890
Provider Business Practice Location Address Fax Number:
619-849-7899
Provider Enumeration Date:
11/02/2021