Provider First Line Business Practice Location Address:
5265 UNIVERSITY AVE
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:
92105-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-376-2176
Provider Business Practice Location Address Fax Number:
619-323-1693
Provider Enumeration Date:
06/18/2024