Provider First Line Business Practice Location Address:
9815 CARROLL CANYON RD STE 101
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:
92131-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-201-8496
Provider Business Practice Location Address Fax Number:
855-821-0667
Provider Enumeration Date:
09/25/2020