Provider First Line Business Practice Location Address:
2305 HISTORIC DECATUR RD STE 100
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:
92106-6071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-353-1789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2019