Provider First Line Business Practice Location Address:
8590 PRODUCTION AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-2281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-632-2823
Provider Business Practice Location Address Fax Number:
866-463-8141
Provider Enumeration Date:
05/01/2017