Provider First Line Business Practice Location Address:
3960 W POINT LOMA BLVD
Provider Second Line Business Practice Location Address:
SUITE H BOX #243
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-5643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-633-7463
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2025