Provider First Line Business Practice Location Address:
13968 AMBER PL
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:
92130-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-527-2627
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2025