Provider First Line Business Practice Location Address:
5405 MOREHOUSE DR STE 120
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:
92121-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-954-5659
Provider Business Practice Location Address Fax Number:
425-230-4884
Provider Enumeration Date:
09/16/2019