Provider First Line Business Practice Location Address:
4116 W POINT LOMA BLVD
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:
92110-5605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-225-1212
Provider Business Practice Location Address Fax Number:
619-225-1726
Provider Enumeration Date:
06/29/2022