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:
619-930-9495
Provider Business Practice Location Address Fax Number:
619-790-7393
Provider Enumeration Date:
08/06/2020