Provider First Line Business Practice Location Address:
2351 CARDINAL LANE, ANNEX B
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:
92123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-573-2227
Provider Business Practice Location Address Fax Number:
858-496-2113
Provider Enumeration Date:
12/05/2023